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HIV-infected women receiving antiretroviral treatment who present for care during the first trimester of pregnancy should be counseled regarding the benefits and potential
risks of antiretroviral administration during this period, and continuation of therapy should be recommended. However,EFV should be avoided during the first trimester of pregnancy.
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While hepatic toxicity is a concern in women with a CD4 count >250 cells/mm3 at the time they first initiate an NVP-containing regimen, an increased risk of hepatic toxicity has not been seen in women who are receiving NVP-based therapy and have immune reconstitution with therapy.
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NVP can be used as a component of initial therapy for pregnant women with CD4 cell
counts <250 cells/mm3, but should only be used as a component of antiretroviral
therapy in pregnant women with CD4 cell counts >250 cells/mm3 if the benefit clearly
outweighs the risk due to an increased risk of hepatic toxicity.
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women in the first trimester of pregnancy who do not require immediate initiation of therapy for their own health may consider delaying initiation until after 10 to 12 weeks gestation.
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Plasma HIV RNA levels should be monitored at the initial visit, 2 to 6 weeks after initiating (or changing) antiretroviral therapy, monthly until RNA levels are
undetectable, and then at least every 2 months during pregnancy; HIV RNA levels
should also be assessed at approximately 34 to 36 weeks gestation for decisions on
mode of delivery
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Most experts would recommend assessment of fetal anatomy with second trimester ultrasound evaluation in women who have received combination antiretroviral therapy (particularly if the regimen included EFV) during the first trimester given the limited data on the effect of combination therapy on the fetus.
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EFV is an FDA Pregnancy Category D drug because of animal data showing an increased risk of central nervous system (CNS) defects and a small number of concerning case reports in humans. EFV should not be used in the first trimester of pregnancy, and women on EFV should be counseled to avoid pregnancy.
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Because of the potential for lactic acidosis with prolonged use of the combination of d4T and ddI by HIV-infected pregnant women, clinicians should not prescribe this antiretroviral combination during pregnancy unless no other antiretroviral options are available and potential benefits outweigh the risks.
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wooooooooooooow.... thanks..now, do w need to know that much??i'm scared..
thanks again
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this antiretroviral therapy reduces the risk of transmission from 25% to 8% or less .
