title: Prevention of mother-to-child transmission of HIV-1: the role of cesarean delivery.
abstract: The risk of mother-to-child transmission (MTCT) of HIV can be reduced through cesarean delivery prior to the onset of labor and prior to rupture of the membranes (elective cesarean delivery [ECD]). As a result of this evidence, the American College of Obstetricians and Gynecologists and the Department of Health and Human Services Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission developed guidelines recommending ECD for HIV-infected women with plasma viral loads of more than 1000 copies/mL. Since the release of the recommendations, an increase in ECD has been seen among HIV-infected women in the United States. This article discusses the evidence on efficacy of ECD, current recommendations in the United States, and risks and morbidity related to ECD. Although the benefit of ECD in preventing MTCT of HIV is substantial, some questions remain. Specifically, the benefit of ECD for women with very low viral loads or for women using combination antiretroviral regimens is unclear, as is the timeframe after onset of labor or rupture of membranes within which ECD will still confer preventive benefits.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, USA. jlegardy@cdc.gov
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Legardy-Williams
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Read
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D015497:HIV-1; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009017:Morbidity; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D019562:Viral Load