Dr. Mofenson recommends that clinicians counseling patients who want to conceive include a discussion about their disease stage, including CD4 cell count, viral load and risk for disease progression over the next two to three years. Some therapies should not be taken during the first trimester of pregnancy because of the risk to the fetus. Women need to decide the regimen that's best for both them and their baby, yet certain presumptions about treatment for HIV-infected individuals still should apply, Dr. Cohen said. Women should be treated like anyone else with HIV infection. However, we don't have enough information about the effects of some of these medications on the newborn, and women should be aware of that, too.
Conception also needs to be discussed in the context of protection for uninfected partners.
That many couples are asking whether they can stop using condoms to conceive points to the need for open communication between patient and doctor about the desire for pregnancy, Dr. Cohen said. For example, new clinical trials of combination therapies using protease inhibitors have shown an increased risk of preterm delivery. Some women had a history of premature infants and shouldn't have been entered into the study. The trials, sponsored by the National Institutes of Health and being conducted at over 50 sites nationwide, currently are being revised to exclude such women, she said. Put on hold as of late June, the trials are expected to reopen in October.