Volume 190 - Issue 4
Variable uptake of recommended interventions to reduce mother-to-child transmission of HIV in Australia, 1982–2005
Authors: Michelle L Giles, Ann M McDonald, Elizabeth J Elliott, John B Ziegler, Margaret E Hellard, Sharon R Lewin and John M Kaldor
Med J Aust 2009; 190 (4): 220-221. || doi: 10.5694/j.1326-5377.2009.tb02359.x
Published online: 16 February 2009
Published online: 16 February 2009
In reply: We were interested in Gilles and colleagues’ response to our analysis of the uptake of interventions to prevent perinatal HIV transmission in Australia.
As Gilles et al state, the reported rates of perinatal HIV transmission are low in Western Australia, where the choice of delivery modality is individualised. We agree that the additional benefit of elective caesarean section in women being treated with highly active antiretroviral therapy with an undetectable viral load is not known.
We also agree that elective caesarean section is associated with potential risks, and women should have a choice regarding mode of delivery. This choice should be informed by other obstetric factors, maternal viral load, and the clinical setting in which delivery takes place.
Geographic variation in such factors is likely, and will certainly contribute to differences across states in the uptake of preventive interventions. Ongoing national surveillance will help ensure that women with HIV infection and their children benefit as much as possible from evidence-based obstetric practices.