In pregnant women who require therapy for their own health, HAART is always advised. There remains a lack of consensus regarding optimum obstetric management of pregnant HIV-infected women in the HAART era. As a result of very low

MTCT rates under effective HAART [1–4], the additional value of selleck screening library an elective CS for PMTCT has been questioned in cases where the HIV RNA load is below detection (usually <40–50 HIV-1 RNA copies/mL). Concerns relate to the risk–benefit balance of elective CS in such circumstances, particularly as HIV-infected women may be more likely to experience postnatal complications than uninfected women, and that women delivering by elective CS are more likely to have complications than those delivering vaginally [20,21]. Some guidelines still recommend an elective CS for women on HAART with undetectable HIV RNA loads [15,16], whereas other guidelines no longer do so [13,14,17,19,22]. In the case of a measurable pre-labour HIV RNA load an elective CS is generally recommended. Our objectives were selleck kinase inhibitor to examine temporal and geographical patterns of mode

of delivery in the Western European centres of the European Collaborative Study (ECS), to identify factors associated with likelihood of elective CS delivery in the HAART era and to explore the associations between mode of delivery and MTCT. The ECS is a birth cohort study, established in 1986, in which HIV-infected women are enrolled during pregnancy and their infants prospectively followed according to standard protocols not [2,23]. The analyses presented here are limited to mother–child pairs (MCPs) enrolled

from the eight participating Western European countries up to the end of 2007. All pregnant women are offered antenatal HIV testing, and those infected invited to participate; pregnant women already known to be HIV-infected on the basis of earlier testing are also invited to take part. Informed consent is obtained before enrolment, according to local guidelines, and local ethics approval has been granted. Information collected at enrolment and during pregnancy includes current antiretroviral treatment (ART), maternal immunological and virological status and mode of acquisition. Maternal CD4 cell counts have been routinely collected since 1992 and HIV RNA measurements from 1998. Laboratory tests were performed locally; all laboratories were based in tertiary care hospitals. Maternal CD4 cell count and HIV RNA level nearest to delivery were used in the analyses. CD4 counts were categorized as <200, 200–499, and ≥500 cells/μL.