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A woman in her 30s entered the clinic, 16 weeks pregnant, to reestablish care for her HIV infection and to start antiretroviral therapy (ART), having previously refused on multiple occasions. Her CD4 count was 237 cells/mm3, and her CD4 percentage was 34% — both stable since her diagnosis in 2007. Her viral load was 427 copies/mL. She was started on AZT/3TC (Combivir) + lopinavir/ritonavir (Kaletra).
One month later, she reported taking her medications daily, but her viral load had not dropped (now 468 copies/mL), and her CD4-cell count had not increased.
How would you manage this patient, both for her own health and for that of her infant?
Two experts have now weighed in with their thoughts on management. View…