Posted by KING from IP 76.18.19.70 on November 30, 2006 at 18:10:59:
A 31-year-old HIV-positive mental health counselor presents to the gynecologist because she suspects that she is pregnant. Her last menses was almost thirteen weeks ago. She was prompted to make today’s appointment because an over-the-counter urine pregnancy test came back positive. She was pregnant once before as a teenager but had an elective abortion. She is not certain how she contracted HIV, but suspects it happened several years ago during a time when she had sexual intercourse with multiple partners and was regularly injecting heroin. After being diagnosed as HIV positive three years ago, she entered drug rehabilitation and has not relapsed. She is able to tolerate the side effects from her three-drug antiretroviral regimen of zidovudine, lamivudine, and saquinavir. At her last visit one month ago, laboratory testing revealed her CD4 count to be 610/µL and HIV load <50 copies/mL. This woman indicates she would like to continue the pregnancy because she recently married "the man of my dreams" and has always wanted to have a child.
Item 1 of 2
Which of the following recommendations is most appropriate given her circumstances?
A) The current antiretroviral regimen should be continued throughout pregnancy
B) The current antiretroviral regimen should be continued throughout pregnancy, but the fetus will have an elevated risk of developing birth defects
C) Efavirenz should be substituted for saquinavir because of concerns about teratogenicity
D) Delavirdine should be substituted for saquinavir because of concerns about teratogenicity
E) The current antiretroviral regimen should be discontinued during pregnancy and resumed immediately after birth