Issue of Concern- Pregnancy with TB and AIDS

[Guest guest]

Dear All,

I wish to share my concern with the forum. It is related to pregnancy with TB

and AIDS.

As per the existing guidelines we cannot use HAART with Nevirapine and Anti TB

drugs with Rifampicin as they interact and results in lower levels of both the

drugs.

It can be used with another anti TB drug Rifabutine but it is too costly (

around Rs 40 - Rs 50 per tab day therapy). Also on the other hand Nevirapine

should not be used in women with CD4 more than 250 due to fear of hepatotoxicity

as per the recommendations. Under the condition it is adviced to use Efavirenz

after 2nd or in 3rd trimester, otherwise we have to use safe PIs (which is very

costly)

I have seen teratogenicity in a child where Efavirenz was used in 2nd and 3rd

trimester at some center.

Under the condition it might be advisable to use Abacavir in place of either

Nevirapine or Efavirenz or other PIs during pregnancy or otherwise we can

continue using Rifampicine and Nevirapine with a bit enhanced dosage and with a

very close followup irrespective of CD4 base line during pregnancy.

Nevirapine is the most widely available nonteratogenic third agent (apart from 2

NRTIs) in resource poor settings and in many clinics in developing countries,

including Haiti ZL Clinics (Zanmi Lasante clinics), is used in the first line

regimen for ART and PPTCT regardless of maternal CD4 count with close hepatic

monitoring.

A large Brazilian study has demonstrated minimal toxicity from this approach.

 

Dr Diwakar Tejaswi MBBS(Gold Medalist); MCH; FCCP; Ph.D.

Consultant Physician and Medical Director

Regional AIDS Training Centre and Network in India(RATNEI)

International Health Organization

Res: MIG 161, Lohianagar,Kankarbagh, Patna 800020, India

India Office: B-33, Indirapuri Colony, Patna 800014, India

Phone: +91-612-3299323 (O); 2586788 (Telefax O); Clinic- Telefax:

+91-612-2206964; Mobile: +91-9835078298; Res: +91-612-2351771

www.ihousa.org

e-mail: <diwakartejaswi@...>