- Validity: 1) Studies not randomized 2) No description of validity
checks 3) Results consistent.
- Biological mechanism(s): possible explanations for decreased transmission
in c-section are: contractions causing maternal-fetal transfusions;
ascending infection after ROM; and exposure, via swallowing or thin
mucous membranes, to maternal secretions and blood in birth canal.
- Need to consider maternal risk of c-section, which is increased in
HIV positive women, especially those with severe disease.
- With use of triple therapy during pregnancy leading to very low viral
loads, will c-section still be beneficial?
- The International Perinatal HIV Group. Mode of delivery and
the risk of vertical transmission of HIV-1. New Engl J Med.
- Semprini AE, Castagna C, Ravizza M, et al. The incidence of
complications after c-section in 156 HIV-positive women. AIDS
- Shaffer N, Roongpisuthipong A, Siriwasin W, et al. Maternal
viral load and perinatal HIV-1 subtype E transmission, Thailand.
J Infect Dis 1999; 179:590-599.
- Kuhn L, Steketee RW, Weedon J, et al. Distinct risk factors
for intrauterine and intrapartum HIV transmission and consequences for
disease progression in infected children. J Infect Dis
- Cosmas Van De Van, M.D., personal communication.