What is the recommended approach to reduce perinatal transmission of HIV in patients with a viral load greater than 1000 copies/mL?

The recommended approach to reduce perinatal transmission of HIV in patients with a viral load greater than 1000 copies/mL is to perform a cesarean section (C-section) prior to the onset of labor. This is a critical intervention because the risk of HIV transmission to the infant is significantly higher during vaginal delivery for mothers with high viral loads. A scheduled C-section minimizes the infant's exposure to maternal blood and bodily fluids during delivery, thereby reducing the risk of transmission.

In the context of managing HIV in pregnancy, the main goal is to keep the viral load as undetectable as possible, especially as delivery approaches. For women with a high viral load, the decision to proceed with a C-section is often made when the viral load does not adequately decrease with antiviral therapy. This preventative measure ensures the safest delivery route for both mother and infant.

Other options, such as vaginal delivery with a condom, using forceps, or performing an episiotomy, do not effectively address the risk of transmission in cases of high viral load and are not recommended strategies. These interventions do not sufficiently reduce contact with potential sources of HIV during the birthing process, making them less effective in preventing transmission compared to a pre-labor C-section.