This case requires serious pharmaceutical intervention in two areas. First, Efavirenz has been documented to cause neural tube defects in the foetus and is contraindicated in pregnancy. Usually zidovudine/lamivudine/nevirapine is the recommended combination for pregnant women. But the fact is that Aminat has a hepatitis co-infection and this regimen may not do much for her liver state. Nucleotide analogs on Current WHO treatment guideline for hepatitis include lamivudine, adefovir, entecavir, telbivudine, tenofovir and emtricitabine. Interferon-alpha and pegylated interferon are effective but costly and inconvenient. They are also contraindicated in pregnancy. Tenofovir is highly favoured cause of its high genetic barrier to resistance . Despite its likelihood to cause fetal bone toxicity, its benefit outweighs the risk. And so in line with WHO recommendation, the prescription will have to be changed to Tenofovir and lamivudine/ emtricitabine combination. If our friend Aminat was not pregnant, we would have added
efavirenz to complete the triple therapy.
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