Elective c-section for women with low HIV loads. (Lower Transmission Rates?).

WASHINGTON -- Elective cesarean sections for HIV-infected women with low viral loads may reduce viral transmission rates beyond those seen with antiretroviral therapy alone.

But the supporting data are not yet strong enough to suggest that cesarean section should be offered to women whose viral loads are less than 1,000 copies/mL, Dr. Howard Minkoff said at the Third World Congress on Controversies in Obstetrics, Gynecology, and Infertility.

Although it has been known for several years that elective cesarean sections effectively reduce HIV transmission to the infants of women with high viral loads, few data have supported the benefit of the procedure in mothers with low viral loads.

Some recent data suggest such a benefit, though they are not robust, said Dr. Minkoff, chair of the obstetrics and gynecology department at Maimonides Medical Center in New York City.

After reviewing national and European studies that documented a substantial decrease in transmission rates with elective cesarean section versus emergency cesarean section and vaginal delivery the American College of Obstetricians and Gynecologists concluded that cesarean sections should be offered to all HIV-infected women. ACOG recommended that the procedure be performed at 38 weeks' gestation to minimize the risk of labor and/or ruptured membranes.

The college noted that insufficient data demonstrate a benefit to women with viral loads of less than 1,000 copies/mL.

Some recent studies seem to indicate that in women with low viral loads, elective cesarean section may reduce the transmission rate beyond what would be ...