QuestionSBA
QuestionChoice
Post-exposure prophylaxis for infants born to HIV-positive mothers is recommended in all cases. Raltegravir, however, is not recommended for this indication. Standard PEP for very low and low-risk babies is zidovudine monotherapy for 2-4 weeks. Combination antiretroviral therapy is recommended in high-risk babies (i.e. those born to mothers with a viral load >50 copies/mL)
10036020
d
Raltegravir administered to the baby (post-delivery)
QuestionChoice
As this patient's HIV viral load is undetectable, a vaginal delivery is acceptable. Elective Caesarean section deliveries were more common before the introduction of highly active antiretroviral therapy.
10036021
e
Elective caesarean section
QuestionChoice
The British HIV Association and Royal College of Obstetricians and Gynaecologists recommend women avoid breastfeeding post-partum, regardless of their viral load and CD4 count, to reduce the risk of vertical transmission. If a woman does decide to breastfeed with an undetectable viral load, they should stop doing so if they develop any nipple bleeding or infections.
10036017
a
Avoid breastfeeding
QuestionChoice
Intrapartum antiretrovirals are indicated for women with a viral load of >1000 RNA copies/mL plasma, untreated HIV-positive patients, and can be considered if the viral load is 50-100 copies/mL plasma. This does not apply in this case as the patient has an undetectable viral load. Further, the antiretroviral of choice for this situation would be zidovudine.
10036018
b
Intrapartum emtricitabine
QuestionChoice
Intrapartum antiretrovirals are indicated for women with a viral load of >1000 RNA copies/mL plasma, untreated HIV-positive patients, and can be considered if the viral load is 50-100 copies/mL plasma. This does not apply in this case. Further, the antiretroviral of choice for this situation would be zidovudine.
10036019
c
Intrapartum tenofovir
Concept
Chapter
2693
6179
HIV mother-to-child transmission
Topic
163
Genitourinary medicine
19607
To minimise vertical transmission of HIV, mothers should avoid breastfeeding, regardless of viral load or CD4 count.
A 30-year-old primigravida at 32 weeks gestation is discussing childbirth with her midwife. She is known to be HIV positive, and is taking antiretroviral therapy. Her latest blood tests show an undetectable HIV viral load and a normal CD4 count.

What is the best strategy to reduce vertical transmission of HIV?
a