SCENARIO

A 27 year old woman is referred to the antenatal clinic at 16 weeks of pregnancy. This is her second pregnancy—her first child, delivered by caesarean section, is now 8 years old. The mother was diagnosed with HIV four years ago when she developed herpes zoster. She has been taking zidovudine, lamivudine, and nevirapine for four weeks through an antiretroviral treatment access programme. At the time of starting treatment, her CD4 count was 124×10⁶ cells/l, her viral load 50 000 copies/ml, and her haemoglobin 104 g/l. She had received a negative screening result for tuberculosis and was receiving daily co-trimoxazole prophylaxis for preventing opportunistic infections. At the 16 week visit she was found to have a haemoglobin concentration of 87 g/l. She is from an African community and has not disclosed her HIV status to her family; she is concerned about the possible stigma associated with not breast feeding her infant.