Is there still a role for Caesarean section in preventing vertical HIV transmission in the era of highly active antiretroviral therapy?

Abstract

Human immunodeficiency virus (HIV) may be transmitted from an infected mother to her child during pregnancy, delivery or breastfeeding. Without any intervention, transmission rates may range from 15-45%. However, this can be reduced to < 5% with effective drug therapy. A scheduled Caesarean section that is performed before the onset of labour or the rupture of membranes has been shown to reduce the intrapartum risk in a meta-analysis of earlier studies. The review further concluded that the benefit of performing an elective Caesarean section outweighed the risk of postpartum morbidity in HIV-infected women. However, balancing the risk to benefit ratio is influenced by the underlying rate of mother-to-child transmission (MTCT) in an individual patient. Caesarean section, while initially shown to reduce the MTCT risk, is itself associated with significant morbidity to the mother. Pregnancy-related sepsis is among the leading causes of maternal deaths, particularly in women who deliver by Caesarean section.