Linda is a 28-year-old female in a discordant relationship with her boyfriend of 1 year. Linda is 12 weeks pregnant based on her last menstrual period. She is engaged in HIV-care and is naïve to antiretroviral therapy (ART) because her CD4 cell count is 538 per mm3 and viral load is 8,300. No tobacco, alcohol, or illegal or illicit drug use.
Physical examination: Normal, healthy 28-year-old gravid female. She is overweight with a body mass index of 28.2.
Laboratory and other tests: Genotype is pan-sensitive without HIV mutations. Ultrasound at her 2-day follow-up estimates she is 15 weeks pregnant.
What are the Public Health Service Panel on Antiretroviral Guidelines for Adults and Adolescents guidelines for HIV-positive pregnant females regarding starting ART? What antiretroviral medications are recommended as first line? Which drugs should be avoided? Provide a rationale for all answers.
What education does Linda need regarding her medication?
Are there any risks to the baby during labor?
What should be done for the baby at birth if he/she tests positive for HIV? What will the providers need to do in terms of monitoring the baby?
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