Indication for LSCS in an HIV infected pregnant lady:
WHO has recommended that, Tenofovir disoproxil fumarate (TDF) + lamivudine (3TC) (or emtricitabine, FTC) + eirenz (EFV) 600 mg as the preferred first- line antiretroviral therapy (A) regimen for adults and adolescents. WHO recommended dolutegravir (DTG) as an alternative option to EFV for first-line A . Cesarean Vs Normal Delivery:There is no paicular benefit of doing a cesarean to reduce the Mother TO Child Transmission. Cesarean section is recommended when the viral load is heavy (>1000 copies) for obstetric and other medical indications but not for HIV per se. Similar recommendations come fromNACO: Caesarean section is not recommended for prevention of mother-to-child-transmission and only if there is an Obstetric indication for the same. Please note, In resource-limited settings ,with absence of ARV drugs or in the case of a high viral load, WHO does not recommend cesarean section.
Viral load is < 1000 copies HIV - RNA/mL
Viral load is > 1000 copies HIV- RNA / mL
Viral load is < 2000 copies HIV - RNA / mL
Viral load is < 50 - 70 copies of HIV - RNA / mL
Infections in pregnancy