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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2007.02.034 Byline: Denise J. Jamieson (1), Jennifer S. Read (2), Athena P. Kourtis (1), Tonji M. Durant (3), Margaret A. Lampe (3), Kenneth L. Dominguez (3) Keywords: cesarean delivery; HIV transmission Abstract: Two studies that were published in 1999 demonstrated that cesarean delivery before labor and before the rupture of membranes (elective cesarean delivery) reduces the risk of mother-to-child transmission of the human immunodeficiency virus (HIV). On the basis of these results, the American College of Obstetricians and Gynecologists and the US Public Health Service recommend that HIV-infected pregnant women with plasma viral loads of >1000 copies per milliliter be counseled regarding the benefits of elective cesarean delivery. Since the release of these guidelines, the cesarean delivery rate among HIV-infected women in the United States has increased dramatically. Major postpartum morbidity is uncommon, and cesarean delivery among HIV-infected women is relatively safe and cost-effective. However, a number of important questions remain unanswered, including whether cesarean delivery has a role among HIV-infected women with low plasma viral loads or who receive combination antiretroviral regimens. Author Affiliation: (1) Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (2) Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, Bethesda, MD (3) Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (proposed), Centers for Disease Control and Prevention, Atlanta, GA. Article History: Received 15 December 2006; Accepted 26 February 2007 Article Note: (footnote) The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Department of Health and Human Services.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2007.03.005 Byline: Stephanie L. Sansom (1), Norma S. Harris (1), Ramses Sadek (1), Margaret A. Lampe (1), Nan M. Ruffo (1)(2), Mary Glenn Fowler (1) Keywords: antiretroviral; perinatal HIV; prevention; surveillance Abstract: The objective of the study was to assess the effectiveness of federal funds in preventing perinatal human immunodeficiency virus (HIV) transmission in the United States. We used surveillance data from 1999 and 2001 in 6 funded areas to estimate the proportion of HIV-infected women prescribed perinatal prophylaxis and whose infants were HIV infected. We compared outcomes with 5 unfunded areas in which surveillance data were available. The proportion of funded-area women prescribed prophylaxis increased from 80.1% to 85.9% (P < .01), compared with a decline in unfunded areas from 95.1% to 86.7% (P < .01); the difference in trends between groups was P < .01. The perinatal HIV transmission rate for funded areas declined from 6.5% (105 cases) in 1999 to 3.4% (46 cases) in 2001 (P < .01), compared with a decline in unfunded areas from 4.3% (19 cases) to 3.4% (13 cases) (P = .59); the difference in trends between groups was P = .24). The number of perinatal HIV infections in the funded areas decreased by 56%, achieving the Centers for Disease Control and Prevention's goal of a 50% reduction in incidence by 2005. Author Affiliation: (1) Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Information Technology Support, Centers for Disease Control and Prevention, Atlanta, GA (2) Northrop Grumman Information Technology, Information Technology Support, Centers for Disease Control and Prevention, Atlanta, GA. Article History: Received 15 December 2006; Revised 14 February 2007; Accepted 1 March 2007 Article Note: (footnote) The findings and views expressed herein are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2007.03.081 Byline: Norma S. Harris (1), Mary Glenn Fowler (1), Stephanie L. Sansom (1), Nan Ruffo (1)(2), Margaret A. Lampe (1) Keywords: antiretroviral; HIV/AIDS; perinatal; surveillance Abstract: Significant reductions in perinatal human immunodeficiency virus (HIV) transmission have been demonstrated in which the HIV-infected mothers and their HIV-exposed infants receive prenatal, intrapartum, and neonatal antiretroviral therapy. Author Affiliation: (1) Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA (2) Northrop Grumman Information Technology, CDC Information Technology Support, Atlanta, GA. Article Note: (footnote) Reprints not available from the authors., Supported by the Centers for Disease Control and Prevention Program announcement 0005., The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2007.06.048 Byline: Mary Glenn Fowler (1), Margaret A. Lampe (2), Denise J. Jamieson (3), Athena P. Kourtis (3), Martha F. Rogers (2) Keywords: acquired immunodeficiency syndrome; human immunodeficiency virus; mother-to-child transmission; pregnancy Abstract: Prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) in the United States and Europe has been a tremendous success, such that transmission rates of less than 2% have been achieved. Some key successes have also been demonstrated in resource-poor countries; however, the translation of successful interventions into public health policy has been slow because of a variety of factors such as inadequate funding and cultural, social, and institutional barriers. The issue of HIV and infant feeding in settings that lack culturally acceptable, feasible, affordable, safe, and sustainable nutritional substitutes for breast milk is a continuing dilemma. An effective preventive infant HIV vaccine would be an optimal approach to reduce HIV acquisition in the first year of life among breast-feeding infants. The challenges to eliminate new perinatal HIV infections worldwide will depend on both sustaining and expanding PMTCT interventions and effective primary HIV prevention for women, adolescents, and young adults. Author Affiliation: (1) Department of Pathology, Johns Hopkins Medical School, onsite Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (2) Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (3) Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Article History: Received 21 June 2007; Accepted 26 June 2007 Article Note: (footnote) The views expressed herein are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.