title: Cesarean section for HIV-infected women in the combination antiretroviral therapies era, 2000-2010.
abstract: OBJECTIVE
  Elective cesarean section (CS) is a proven method to prevent mother-to-child transmission (MTCT), but is no longer recommended for women with antiretroviral therapy resulting in a low viral load (VL): <400 copies/mL in French and <1000 copies/mL in US guidelines. We sought to describe mode of delivery practices in human immunodeficiency virus (HIV)-infected women and their association with MTCT and postpartum complications.
  
  
  METHODS
  All deliveries from HIV-1-infected women in the French Perinatal Cohort (Agence Nationale de Recherches sur le Sida/Enquête Périnatale Française) 2000 through 2010 (N = 8977) were analyzed, with additional details for 2005 through 2010 (n = 4717).
  
  
  RESULTS
  Vaginal deliveries increased from 25% in 2000 to 53% in 2010. Over 2005 through 2010, 4300 women had VL before delivery <400 copies/mL; among them only 49.3% delivered vaginally, 22.0% had nonelective CS, and 28.7% had elective CS. Elective CS were performed for scarred uterus in 45.4%, other obstetrical indications in 37.1%, and solely because of HIV in 15.7%. Of the 417 women with VL ≥400 copies/mL, 48.9% had elective CS as recommended, 25.9% had nonelective CS, and 25.2% had vaginal delivery. The MTCT rate did not differ according to the mode of delivery in term deliveries (≥37 gestational weeks) in 2000 through 2010: 0.3% after both vaginal delivery and elective CS with VL <50 copies/mL, 4.0% vs 5.3%, respectively, with VL ≥10,000 copies/mL. In case of preterm delivery, MTCT rates tended to be higher with vaginal delivery. Postpartum complications were more frequent following CS than vaginal deliveries (6.5% vs 2.9, P < .01).
  
  
  CONCLUSIONS
  Our findings suggest that HIV-infected women on antiretroviral therapy with low VL can safely opt for vaginal delivery in the absence of obstetrical risk factors.
authors.affiliation: Inserm, Center for Research in Epidemiology and Population Health U1018, Le Kremlin-Bicêtre, France; Université Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: Nelly
authors.initials: N
authors.lastname: Briand
authors.forename: Carine
authors.initials: C
authors.lastname: Jasseron
authors.forename: Jeanne
authors.initials: J
authors.lastname: Sibiude
authors.forename: Elie
authors.initials: E
authors.lastname: Azria
authors.forename: Justine
authors.initials: J
authors.lastname: Pollet
authors.forename: Yamina
authors.initials: Y
authors.lastname: Hammou
authors.forename: Josiane
authors.initials: J
authors.lastname: Warszawski
authors.forename: Laurent
authors.initials: L
authors.lastname: Mandelbrot
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011446:Prospective Studies; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
keywords: cesarean section; human immunodeficiency virus; mode of delivery; mother-to-child transmission; viral load