What is the role of blood counts and viral load in the ongoing monitoring of pregnant women with HIV infection?

Updated: Apr 02, 2019
  • Author: Ashley T Peterson, MD; Chief Editor: Ronald M Ramus, MD  more...
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Answer

For pregnant women infected with HIV, in addition to the standard prenatal assessment, continued assessment of HIV status is important. A complete blood count to assess anemia and white blood cell count as well as renal and liver function tests should be included. Initial evaluation includes CD4+ counts, which help determine the degree of immunodeficiency.

Viral load, determined by plasma HIV RNA copy number (copies/mL) assesses the risk of disease progression. The viral load is important in decisions regarding maternal treatment and delivery management; however, because perinatal HIV transmission can occur even at low or undetectable HIV RNA copy numbers, the viral load is not used to decide whether to start antiretroviral medications. Moreover, newer guidelines now recommend initiation of ART for all HIV-infected individuals, regardless of CD4 count, to reduce the morbidity and mortality associated with HIV infection and the risk for all modes of transmission.

If a viral load is detected, antiretroviral drug resistance studies (HIV genotype) should be sent but providers should not wait for results before initiation of ART. In general, pregnancy has not been associated with a risk of rapid progression of HIV. [17] With appropriate therapy, the viral load should drop by 1 log within the first month and become nondetectable within 6 months after initiating treatment. The higher the viral load, the longer the decrease may take; however, if the viral load persists or increases at 6 months, treatment failure must be considered.


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