| Case Study 1 |
| Agnes is a 28-year-old woman from South Africa. She arrived in Australia 6 months ago and has no family supports. She is diagnosed as having HIV infection and she is also 10 weeks pregnant. She is non-Medicare eligible at this time. Initial investigations indicate a CD4+ T cell count of 190/μL and a plasma HIV RNA level of 43 000 copies/mL. What are the key issues for this young woman that need to be considered and the possible solutions that are available? |
| Case Study 2 |
| Samuel was diagnosed as having HIV infection in 2005. He has been in a relationship with Sue for the past 7 years and they are now very keen to have a child. Sue has been engaged in long-term counselling regarding severe anxiety, including ongoing anxiety about acquiring HIV. Samuel is currently on Biktarvy and his HIV viral load has been undetectable for the past 10 years. What are the key issues for this couple and the available solutions? |
| In summary
· ART in pregnancy is the standard of care and is commenced regardless of CD4+ T cell count, HIV viral load or stage of disease. · When all recommended strategies are implemented, the mother-to-child transmission risk is now considered to be below 1% in developed world settings. · ART should be commenced as soon as possible if the woman is not already on therapy (but some women may prefer to wait until after the first trimester if ART-naive). · Choice of specific antiretroviral drug relates to demonstrated efficacy and safety. · Two drug regimens are not recommended during pregnancy. · ART is continued after delivery for all HIV infected women. · Refer to guidelines and colleagues experienced in the management of both HIV infection and pregnancy. · Women with HIV infection require more frequent monitoring during pregnancy. · Management of pregnant woman with HIV infection requires a coordinated team approach – HIV physician, obstetrician, paediatric HIV specialist for the baby, midwives and allied health staff. |