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Commentary
May 26, 1999

Prophylactic Cesarean Delivery for the Prevention of Perinatal Human Immunodeficiency Virus TransmissionThe Case for Restraint

Author Affiliations

Author Affiliations: Center for Research on Women's Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham.

JAMA. 1999;281(20):1946-1949. doi:10.1001/jama.281.20.1946

The introduction of viral protease inhibitors into combination antiretroviral regimens has dramatically changed human immunodeficiency virus (HIV) therapeutics. Capable of suppressing measurable viral loads to undetectable levels, combination therapy has improved clinical status1 and prolonged survival2,3 for many patients in the developed world and is now firmly established as standard of care in the United States.4 Recently, in an effort to afford these same benefits to HIV-infected pregnant women, the US Public Health Service has recommended that combination antiretroviral therapy be offered during pregnancy as well.5 As an associated effect, several centers that have implemented these recommendations have observed perinatal HIV transmission rates approaching zero among women receiving combination agents69; by comparison, the HIV transmission risk in untreated, non–breast-feeding women in the developed world is 14% to 25%,10 which can be reduced to as low as 5% with zidovudine monotherapy.11,12

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