HIV IN PREGNANCY

See also under "Antitretroviral Therapy" for info on antiretrovirals for prevention of vertical HIV transmission

Risk of mother-to-child transmission of HIV without antiviral treatment is 15-35%

Breastfeeding can transmit HIV, and abstention from breastfeeding reduces risk of HIV transmission

Studies suggesting reduced vertical transmission with delivery by c/s:

• Delivery by elective c/s ass'd with sig. less risk (0.8% vs. 6.6%) of vertical transmission of HIV than vaginal delivery in a nonrandomized prospective cohort study if 2834 births, but only in those cases where mom used AZT during pregnancy--not in those where mom didn't. (JAMA 280:55, 1998)
• RR for HIV transmission was 0.55 with c/s for those moms who had no antiretroviral therapy and 0.10 for those who did have antiretroviral therapy in a meta-analysis of 15 prostpective studies on 8,533 maternal-infant pairs (NEJM 340:977, 1999--JW)
• In a randomized study of vaginal vs. c/s in 408 HIV-infected women (2/3 also got antiretrovirals), RR for transmission was 0.17 for the c/s group (intention-to-treat analysis) (Lancet 353:1035, 1999--JW)
• Among a cohort of women with undetectable HIV RNA levels, elective c/s was associated with sig. lower risk of maternal-to-fetal HIV transmission c/w emergency c/s or vaginal delivery (Clin. Inf. Dis. 40:458, 2005--JW)