How is vertical transmission minimized?

• A. Delivery by cesarean in all cases regardless of VL.
• B. Maternal ART with undetectable VL near delivery reduces transmission.
• C. Breastfeeding is always recommended.
• D. Neonatal prophylaxis is unnecessary if mother is on ART.

Answer: (B)

The most effective way to minimize vertical transmission is maternal antiretroviral therapy that achieves an undetectable viral load near delivery. When the viral load is suppressed to undetectable levels, there is far less HIV in the blood and genital secretions at the time of delivery, so the chance of exposing the infant during labor is dramatically reduced—often well under 1%. This single factor has the biggest impact on preventing transmission, and it also benefits the mother’s health.

Cesarean delivery in all cases regardless of viral load isn’t necessary and carries surgical risks; if the viral load is not suppressed, cesarean may be considered in some circumstances, but not as a universal rule. Breastfeeding can transmit HIV through breast milk, so it isn’t always recommended where safe formula feeding is available. Neonatal prophylaxis remains part of the prevention strategy even when the mother’s viral load is undetectable, providing an additional layer of protection for the newborn.