The international main goal is to reduce mother-to-child HIV transmission. The appropriate birth delivery for seropositive woman has been analyzed since the beginning of the twenty-first century. Although at the beginning of HIV pandemic delivery by caesarian section (C-section) was considered mandatory in many studies and meta-analyses, recent information reveal limited benefits. Mother-to-child transmission is higher when mothers are diagnosed late during pregnancy, in advanced stages with a high HIV viral load, and labor with membranes ruptured for more than 4 h, especially when the antiretroviral treatment is not respected. During vaginal delivery, the risk of HIV transmitting to infant is due to microtransfusions during uterine contractions or by newborn exposure to cervicovaginal secretions or blood. Although the indication of C-section in HIV-positive women is controversial, there are some situations in which C-section remains mandatory. In mothers diagnosed late during pregnancy, in situation in which HIV viral load is not affordable in real time in the last trimester of pregnancy, and in mothers with poor adherence to antiretroviral treatment, C-section remains one of the most important measures of prevention for HIV mother-to-child transmission.
Part of the book: Caesarean Section
Prevalence of hepatitis C in HIV infected patients is much higher than in the general population. There is the possibility of viral clearance HCV, in some patients co-infected HIV and HCV, in the phase of immune reconstruction after antiretroviral treatment (ART). There are patients’ anti-HCV positive who initially did not show HCV viral load detected and after the start of ART becomes HCV viral load detectable. There are studies that described that immune restoration with increase in CD4+ and CD8+ T cells, from ART, was important in control of HCV viremia. Has been proposed hypothesis that direct or indirect effect of ART on HCV replication play a role in spontaneous resolution of HCV infection. We evaluated the co-infected patients with HIV and HCV under combined antiretroviral treatment, containing PI boosted with ritonavir in terms of immunological and virological status (for both infection) and also liver disease. Patients were evaluated for liver damage by non-invasive methods. We have shown that a small percentage of patients have severe liver damage. We demonstrated the negative role of HCV on immunological status and in liver fibrosis in co-infected patients. A high proportion of these HIV and HCV co-infected patients had no detectable viremia, higher than other studies published.
Part of the book: Advances in Hepatology