When is it appropriate to start antiviral therapy for HIV-positive pregnant women?

Starting antiviral therapy for HIV-positive pregnant women is appropriate regardless of the CD4 count. This approach is based on the understanding that initiating treatment early during pregnancy can significantly reduce the risk of mother-to-child transmission of HIV.

Research has shown that effective antiretroviral therapy not only protects the health of the mother but also greatly decreases the likelihood of the virus being transmitted to the fetus or newborn during pregnancy, labor, and delivery. Timing is crucial in these cases; initiating therapy as soon as a woman is diagnosed with HIV, even in early pregnancy, helps achieve viral suppression. By lowering the viral load to undetectable levels, the risk of transmission diminishes substantially.

Other options reflect strategies that do not align with the current guidelines recommending immediate initiation of treatment. For instance, waiting until the first trimester is complete or until the CD4 count is below a certain threshold delays critical treatment and increases the risks associated with the disease for both the mother and the baby. Additionally, waiting until after delivery fails to provide the necessary care during pregnancy that can protect the child from infection. Thus, starting antiviral therapy during pregnancy, regardless of the CD4 count, is a proactive and essential measure in the management of HIV.