If an HIV-positive woman does not have a completely suppressed viral load, what is the recommended delivery method?

For an HIV-positive woman who does not have a completely suppressed viral load, a scheduled cesarean section is recommended to minimize the risk of HIV transmission to the infant during delivery. When the viral load is not fully suppressed, the likelihood of viral particles being present in the maternal secretions increases, which can lead to exposure of the baby at the time of birth.

A scheduled cesarean delivery can significantly reduce the risk of perinatal transmission compared to vaginal delivery, especially if performed before the onset of labor or rupture of membranes. This approach is particularly crucial for women with a high viral load, as the risk of transmission during a vaginal delivery is higher.

Maintaining a low viral load, ideally less than 1,000 copies/mL, is the goal of antiretroviral therapy during pregnancy. However, if the viral load is detectable and above that threshold at the time of labor, the comprehensive recommendation is to schedule a cesarean delivery to protect the child from potential infection.