Empathy in Infection and Immunology Module

Trigger 2
In this case, first of all I would suggest the patient to recheck the CD4+ count and viral load, with the
routine blood work. Following the test, I would ask for the drugs she has used for the past 4 months,
because if she was using efavirenz it is not suggestible during the first trimester in pregnancy. After
those confirmation tests I would suggest a genetic counseling for the pregnancy.
For the therapy, I would change the anti-retroviral regimen by including zidovudine. Zidovudine is
known for stopping vertical transmission of HIV. I would also avoid nevirapine if the patients CD4+
count is higher than 250 cells/uL. So the regimen will be 150mg lamivudine with 200mg zidovudine
pills. If the viral load of HIV shows more than 400 copies /mL, at time of delivery I would suggest
intrapartum zidovudine 2mg/kg IV for 1 hour, followed by intravenous infusion of 1mg/kg/h from
onset of labor to delivery.
For the counseling, I would bring the patient to conclusion without suggesting that she should tell
her husband about the HIV, and if the husband, which came from low education background needs
to know more, I can elaborate to both of them. Also without giving false hope, I would let her know
that there might be a chance that with this drug regimen, the baby wont be transmitted, but she
wont be able to breastfeed her baby because HIV can also be transmitted from breastmilk.