A number of missed opportunities for using this therapy were identified. Surprisingly few reports dealt with combination antiretroviral therapy in pregnancy, and none had results to report from any of the clinical trials of these combinations now in progress. In none of the studies were women treated with antiretrovirals other than AZT, and viral load measurements were not reported. The widespread use of this strategy in developing countries raises further concerns. It seems very possible, however, that a subgroup of women who are unable to achieve appropriate reductions in viral burden may reasonably consider the option of operative delivery.
More study is needed.
Despite the enormous progress in reducing perinatal transmission, the global burden of this problem remains staggering. The overwhelming majority of these are born in developing countries where there is limited access to all of the therapies suggested above. Bridging this gap remains only a dream. Natural History Several intriguing studies reported gender differences in viral load that could have implications for starting antiretroviral therapy. Initial median viral load after seroconversion was approximately 69,000 in men and 15,000 in women.