Is elective caesarian section really essential for prevention of mother to child transmission of HIV in the era of antiretroviral therapy and abstinence of breast feeding?

Abstract

Aim: To determine whether vaginal delivery along with antiretroviral therapy and avoidance of breast feeding is safe in preventing mother to child transmission (MTCT) of HIV. Setting: Pediatric and Perinatal HIV clinic, B.J. Wadia Hospital for children, Mumbai. Study design: Retrospective analysis. Methods and materials: 222 HIV-infected pregnant women were treated with zidovudine from 14 weeks of gestation onwards. 174 women underwent an elective caesarian section whereas 48 women delivered spontaneously vaginally. All infants were treated with zidovudine for 6 weeks and breast feeding was withheld. The HIV status of infants was determined at 18 months by ELISA test. Results: Of the 174 infants delivered through LSCS delivery, two were HIV infected whereas 172 (98.9%) were HIV uninfected. Of the 48 infants delivered vaginally, 47 (97.9%) were HIV negative and one child was HIV infected. Thus, elective caesarean section was not statistically better as compared to vaginal delivery (p=0.8696) suggesting that vaginal delivery was as effective as caesarean section for prevention of MTCT of HIV when added with antiretroviral therapy and no breast feeding. Conclusion: Vaginal delivery along with antiretroviral therapy in mother and baby and avoidance of breast feeding is equivalent to that of an elective LSCS delivery for prevention of mother-to-child transmission of HIV. Surgical intervention may thus not be required in these women. © 2006 Oxford University Press.