Close liaison with the obstetric team is recommended. 4.2.6 In the event that a woman who has initiated HAART during pregnancy has not achieved a plasma VL of <50 copies/mL at 36 weeks the following interventions are recommended: Grading 1C Review
adherence and concomitant medication. Perform resistance test if appropriate. Consider TDM. Optimize to best regimen. Consider intensification. this website For a woman who conceives on HAART that is not fully suppressive or loses virological control during pregnancy, these interventions should be undertaken as soon as possible. If treatment failure occurs when the infant is likely to be delivered prematurely and may be unable to take medication enterally, intensification should consist of therapies that readily cross the placenta such as double-dose tenofovir, raltegravir and single-dose nevirapine. “
“The aim of the study was to evaluate the predictive value of clinical and molecular risk factors, including peripheral blood mononuclear cell (PBMC) mitochondrial DNA (mtDNA) and mitochondrial RNA (mtRNA), for the development of lactic acidosis (LA) and symptomatic hyperlactataemia (SHL). In a substudy of a large multicentre, randomized trial of three antiretroviral regimens, all containing
didanosine (ddI) and stavudine (d4T), in antiretroviral-naïve, HIV-1-infected patients, Lumacaftor manufacturer patients with LA/SHL (‘cases’) were compared with those without LA/SHL in a univariate analysis, with significant parameters analysed in a multivariate model. In a molecular substudy, PBMC mtDNA and mtRNA from
cases and matched controls at baseline and time of event were examined. In 911 subjects followed for a median of 192 weeks, 24 cases were identified (14 SHL and 10 LA). In univariate analysis, cases Rebamipide were more likely to be female (P=0.05) and to have a high body mass index (BMI) (P=0.02). In multivariate analyses, only BMI remained an independent predictor of the development of LA/SHL (P=0.03). Between cases and controls there was no significant difference in mtDNA copy number at baseline (389 vs. 411 copies/cell, respectively; P=0.60) or at time of event (329 vs. 474 copies/cell, respectively; P=0.21), in the change in mtDNA copy number from baseline to event (−65 vs. +113 copies/cell, respectively; P=0.12), in mtRNA expression at baseline or time of event, or in the change in mtRNA expression from baseline to event. The development of LA/SHL was associated with increased BMI, but PBMC mtDNA and mtRNA did not predict LA/SHL. This demonstrates the ineffectiveness of routine measurement of PBMC mtDNA in patients on ddI and d4T as a means of predicting development of LA/SHL. Highly active antiretroviral therapy (HAART) has greatly reduced mortality and morbidity in patients with HIV-1 infection .