Preconception Counselling HIV — SCE Infectious Diseases MCQ

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ModerateHIV MedicinePreconception Counselling HIVSCE Infectious Diseases

A 42-year-old woman with HIV (CD4 620, VL <50) on DTG/TAF/FTC attends for preconception counselling. She also takes Sodium Valproate for epilepsy. What is the critical issue?

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Correct answer: B — Sodium Valproate is teratogenic (neural tube defects) and must be switched before conception — this is independent of HIV/ART considerations

The critical issue here is Sodium Valproate, which is a well-established teratogen (neural tube defects, craniofacial and cardiac malformations, neurodevelopmental impairment). MHRA regulations now restrict Valproate prescribing in women of childbearing potential. It must be switched to a safer antiepileptic before conception. DTG is now considered safe periconceptionally (updated BHIVA 2025 pregnancy guidelines following reassuring Tsepamo data). This question tests the ability to identify the non-HIV medication as the primary risk.

Reference: MHRA 2024 – Valproate Pregnancy Prevention Programme; BHIVA 2025 – HIV in pregnancy