The introduction of viral
protease inhibitors into combination antiretroviral regimens has
dramatically changed human immunodeficiency virus (HIV) therapeutics.
Capable of suppressing measurable viral loads to undetectable levels,
combination therapy has improved clinical status1 and
prolonged survival2,3 for many patients in the developed
world and is now firmly established as standard of care in the United
States.4 Recently, in an effort to afford these same
benefits to HIV-infected pregnant women, the US Public Health Service
has recommended that combination antiretroviral therapy be offered
during pregnancy as well.5 As an associated effect, several
centers that have implemented these recommendations have observed
perinatal HIV transmission rates approaching zero among women receiving
combination agents6- 9; by comparison, the HIV transmission
risk in untreated, non–breast-feeding women in the developed world is
14% to 25%,10 which can be reduced to as low as 5% with
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