Is She or Isn't She?

An HIV-infected pregnant woman says she's taking her antiretrovirals — but the blood test results say otherwise. Two experts describe their approach to management.

A few weeks ago, we described the case of an HIV-infected pregnant woman whose medication adherence was in question. Since then, readers have provided various suggestions about how to manage the situation. Now, two experts weigh in.

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),…

Is She or Isn't She?

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