Authored By: B. V Waghmare

Sunday, August 31, 2008

Pregnancy with TB and AIDS HIV a important issue

Pregnancy with TB and AIDS HIV a important issue
As per the existing guidelines we cannot use HAART with Nevirapine and Anti TB drugs with Rifampicin as they interact and results in lower levels of both the drugs. It can be used with another anti TB drug Rifabutine but it is too costly ( around Rs 40 - Rs 50 per tab day therapy). Also on the other hand Nevirapine should not be used in women with CD4 more than 250 due to fear of hepatotoxicity as per the recommendations. Under the condition it is adviced to use Efavirenz after 2nd or in 3rd trimester, otherwise we have to use safe PIs (which is very costly)I have seen teratogenicity in a child where Efavirenz was used in 2nd and 3rd trimester at some center.Under the condition it might be advisable to use Abacavir in place of either Nevirapine or Efavirenz or other PIs during pregnancy or otherwise we can continue using Rifampicine and Nevirapine with a bit enhanced dosage and with a very close followup irrespective of CD4 base line during pregnancy.Nevirapine is the most widely available nonteratogenic third agent (apart from 2 NRTIs) in resource poor settings and in many clinics in developing countries, including Haiti ZL Clinics (Zanmi Lasante clinics), is used in the first line regimen for ART and PPTCT regardless of maternal CD4 count with close hepatic monitoring.A large Brazilian study has demonstrated minimal toxicity from this approach.


Information on HIV Virus and AIDS symptoms

Last updated: 31-Oct2008

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