Professor Andrew Whitelaw, Infection Control Society of Southern Africa
A 27-year old woman was diagnosed with HIV in 2005 and started on ART. She has complex social circumstances and defaults recurrently. In February 2012 she presents to the clinic at 28 weeks pregnant, after defaulting ART for the seventh time in May 2011. Previous treatment regimens included the following:
3TC, NVP, D4T,
3TC, AZT, NVP
TDF, 3TC, EFV - defaulted May 2011
At this stage she has an absolute CD4 count of 75 cells/mm3 and a viral load of 52 905 copies/ml. She is initiated on TDF, 3TC, Aluvia (Lopinavir / ritonavir).
Shortly after starting ART again in Feb 2012 she is diagnosed with INH mono-resistant tuberculosis, on a line probe assay.
The baby is born at 36 weeks gestation with a birth weight of 2840g, and is clinically well at birth.
Question 1: HIV Issues
A) What is the best ARV strategy for an infant whose mother is failing second line treatment?