When your wellness is affected by HIV, it’s more than just a matter of your sexual health. If you have children, their well-being is at risk of the infection, which is why elective caesarean section delivery (a caesarean performed before the onset of labour) has been recommended for HIV-positive women since 1999. However, though this measure has been shown to reduce the risk of mother-to-child transmission of HIV, a new study, published in the Journal of Acquired Immune Deficiency, asserts that there are “missed opportunities” for HIV-positive pregnant women with a suppressed viral load to give birth vaginally.
In Europe, it is recommended, or permissible, for you to deliver vaginally if you have an undetectable or very low viral load, but, according to the investigators, more than a third of women with viral suppression and no contraindications still have a caesarean section. The study authors commented, ‘Rates of vaginal deliveries were lower than expected. Our results suggest that the policy for vaginal delivery among women among women with undetectable or very low VL [viral load] is only slowly becoming established within practice over time.’
Across Europe, rates of mother-to-child transmission have declined dramatically, reaching rates of below 1%. This is thanks to the widespread use of combination anti-retroviral therapy, rather than the common practice of elective caesarean section. Wellness experts have questioned the additional benefits of delivering via caesarean, with particular regard to the risks of the procedure itself. As guidelines across Europe for the management of HIV infection during pregnancy have been changed over the past decade, the study researchers wanted to investigate whether or not this had had an impact on low viral-load women giving birth vaginally.
For the study, the researchers examined data collected between 2000 and 2010 in two studies (the European Collaborative Study and the Swiss Mother and Child HIV Cohort Study). They looked at data on 3013 deliveries to 2663 women, and found that, after the guideline changes, caesarean section was the mode of delivery for 55% of women with an undetectable viral load. The study authors concluded, ‘Rates of vaginal delivery in HIV-positive pregnant women are increasing for women with suppressed VL. Despite this, there is evidence of missed opportunities for viral suppression and for having a vaginal delivery in women with a suppressed viral load.’
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