How should HIV infection impact pregnancy and delivery planning?

• A. Deliver by planned cesarean regardless of viral load.
• B. Stop ART during delivery.
• C. Start ART to reduce vertical transmission; plan delivery based on viral load and obstetric factors; breastfeeding discouraged in high-income countries; neonate prophylaxis and possibly ART.
• D. Breastfeeding is encouraged for all settings.

Answer: (C)

Preventing mother-to-child transmission of HIV hinges on keeping the maternal viral load suppressed with antiretroviral therapy throughout pregnancy and planning delivery based on how well the virus is controlled and other obstetric factors. Start and continue ART during pregnancy to achieve viral suppression; stopping ART at delivery would raise the risk of transmitting HIV to the baby. Delivery should be planned and individualized: if the viral load is undetectable near term, vaginal delivery is an option; if viral load remains high or suppression hasn’t occurred, a planned cesarean before labor may be recommended to lower transmission risk. In high-income countries, breastfeeding is discouraged for HIV-infected mothers because the virus can be transmitted through breast milk, so formula feeding is advised when feasible. The newborn should receive prophylaxis after birth, and depending on the level of maternal risk, the infant may also receive antiretroviral therapy. This combination approach best minimizes perinatal HIV transmission while protecting both mother and baby.