Review Question - QID 102539

This patient is presenting with a diagnosis of HIV given her laboratory tests, low CD4 count, and high viral load. All pregnant women should be started on HAART.

Management of a HIV infected pregnant patients typically focuses on primary treatment of the HIV-infected mother and reduction of the risk of mother-to-child transmission of the disease. Pharmacologic therapy should be given in the antepartum and intrapartum periods as well as to the infant after birth. The cornerstone of treatment is centered on HAART and all pregnant patients with HIV should either continue their HAART regimen or be started on one to protect the mother and fetus.

Incorrect Answers:
Answer 1: Avoidance of antibiotic prophylaxis is incorrect as this mother is at risk of opportunistic infections and should be started on appropriate antibiotics to prevent infection while considering the effect on the fetus (for example, avoiding antibiotics such as doxycycline).

Answer 2: Breastfeeding should not be performed in a pregnant mother with HIV as it could transmit the infection to the fetus.

Answer 4: HAART after delivery is incorrect and puts the mother and fetus at risk for an HIV infection. HAART therapy should be started immediately.

Answer 5: Vaginal delivery is generally avoided in patients with low CD4 counts and high viral loads (though vaginal delivery is acceptable when there is a very low viral load and the patient is on HAART).

Bullet Summary:
Pregnant patients with HIV should be started on HAART, given prophylactic antibiotics (per their CD4 count), avoid vaginal delivery if the viral load is high, and avoid breastfeeding.