Management of an HIV-positive pregnant woman to minimize vertical transmission includes what?

• A. No treatment required during pregnancy
• B. Antiretroviral therapy during pregnancy with viral load monitoring and plans for delivery; avoid breastfeeding if possible
• C. Only monitor CD4 count, no ART
• D. Breastfeeding is mandatory

Answer: (D)

The key idea is that preventing mother-to-child transmission of HIV hinges on reducing the virus in the mother and carefully planning feeding after birth. The most effective approach is to give antiretroviral therapy during pregnancy (and continue as indicated), monitor viral load, plan delivery to minimize infant exposure, and address feeding to reduce postnatal transmission. In many settings, exclusive or permitted breastfeeding with the mother on effective ART (and, when appropriate, infant prophylaxis) is a central part of reducing transmission while also ensuring the infant receives the benefits of breast milk. So, continuing breastfeeding, when managed with proper ART and follow-up, fits the goal of minimizing vertical transmission in this context.

Other choices fail to address the transmission risk adequately: not treating during pregnancy leaves a high chance of transmission; monitoring CD4 count alone doesn’t impact viral load; and claiming breastfeeding is universally mandatory ignores the real-world need to balance feeding safety and transmission risk with ART.