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HIV in Pregnancy

In Africa, weíll see that seroprevalence now is not measured per hundred-thousand population. It is measured percent, that is per-hundred people. We are looking at a thousand times more people infected, on the average or approximately, in Africa than in our own country. In addition, in Africa orphans are not measured or orphans of the epidemic are not measured in terms of per hundred-thousand population or per hundreds or thousands of children. They are measured in terms of millions of children in different countries. Certainly Uganda, in terms of children under age 15 who have lost their parents to AIDS is at, or was at earlier this

Starting in 1994 zidovudine was offered to all of our mothers. In Ď96-í97 our emphasis evolved to a focus on the use of anti-retroviral therapy to actually control maternal disease. In these years we offered two drugs for a certain viral burden - less that 1,000 - and three drugs for what we determined to be more advanced disease, or more active disease. Since pregnancy

The NIH guidelines came out with principle VIII stating that women should receive optimal anti-retroviral therapy regardless of pregnancy or reproductive status. The oldest children who

The option for all of our clients who are anti-retroviral naïve is to delay initiation of therapy until 14 weeks gestation. This is for two reasons. By far the most important reason is that women

For women who are already on therapy and tolerating it well, we find that the vast majority of our clients continue to tolerate the therapy well during first trimester, so that we leave it completely up to them as to whether they want to interrupt their therapy or continue it during

We emphasize to our clients that transmission events can take place at all viral loads, so that off of therapy a low viral burden does not necessarily mean that a baby Ö a low maternal viral

Just a few routine practices on labor and delivery. A history of herpes is always important to elicit and itís always important to diagnose any lesions, whether mom is antepartum or presenting in labor. We always aggressively rule out ruptured membrane and if the membranes have been ruptured, we embark on an aggressive oxytocin augmentation of labor and we donít even wait for intravenous zidovudine to come up from the pharmacy. We want to get labor underway as soon as possible, start the zidovudine as soon as possible and deliver the baby

IV zidovudine: itís only purpose is to prevent vertical transmission so it can be simply discontinued when the cord is clamped. When in doubt about labor, just start the IV zidovudine. Thereís no reason to hold off to see if mom is in labor or not. It can always be

Now the majority of our mothers have been on three drugs. Still a number requesting two drugs. A number still on one drug and a couple with no prenatal care who took no

Itís very interesting to talk a little bit about these women up here. For these three clients with higher viral burdens, they were all in care. They were on therapy and indeed these values, although they are not undetectable, represent markedly suppressed values from baseline. Anywhere from 1-2 logs below their baseline value. So that while we were worried while