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- Approximate risk of mother to child transmission (MTCT) of HIV is 15-30% for live births (mostly intrapartum) and 15% during breastfeeding. Taken together risk of HIV transmission during pregnancy, delivery, and breastfeeding is approximately 20-40% without prevention measures (without PMTCT).
- Risks include higher maternal VL, lower CD4 count, severe prematurity (< 33 wks), multiple gestation (twin A at higher risk), smoking, active HSV, genital ulcer disease. Risk lower with low VL, effective ART, Cesarean section delivery (when VL not suppressed), intrapartum ART, formula feeding.
- Antenatal and post-natal PMTCT can decrease transmission to < 1%.
- Pregnancy does not increase HIV progression, risk of OIs, or HIV-related survival. Hemodilution of pregnancy may cause apparent decrease in absolute CD4 (not CD4%).