Role for T-20 in pregnancy, says study

A case report published in the September 24^th edition of AIDS shows the potential value of adding T-20 (enfuvirtide, Fuzeon) to a failing HAART regimen to prevent mother-to-baby transmission of HIV.

In early 2003 a 38-year-old woman who was first diagnosed with HIV in 1990, became pregnant. At the time she was taking 3TC, tenofovir and lopinavir/ritonavir (Kaletra). However this regimen was failing to control HIV replication and the woman had an HIV viral load of over 40,000 copies/ml. Her CD4 cell count was 356 cells/mm³.

The woman had taken numerous antiretroviral treatment regimens starting in 1994. A resistance test during August 2003, the eighth month of her pregnancy, revealed that she was resistant to all available medication in both the nucleoside analogue (NRTI) and protease inhibitor classes of antiretroviral drugs.

Three weeks before the woman underwent an elective caesarean, doctors added the non-nucleoside analogue (NNRTI) nevirapine (Viramune), a drug know to be effective at preventing maternal HIV transmission (the woman did not have any mutations conferring resistance to NNRTIs), and T-20 to her existing drug regimen. At the time of delivery, the woman had a viral load of 57 copies/ml and a CD4 cell count of 549 cells/mm³.

In early September 2003 the woman was delivered of a healthy baby girl weighing 2.9kg. The infant was treated at birth with AZT (zidovudine), 3TC (lamivudine) and nevirapine, a standard regimen given to babies of mothers with detectable HIV viral loads after delivery to prevent infection with HIV. Polymerase chain reaction (PCR) testing at day 3, and at months 1,3 and 6 confirmed that the baby was not infected with HIV.

At six months both the mother and her baby were well, with no signs of any adverse effects due to the addition of T-20.

"This case shows the potential value of [T-20] in preventing maternofetal HIV transmission," conclude the study's authors.