An HIV-positive mother is in her last trimester of pregnancy. Which of the following statements is correct regarding prevention of mother-to-child transmission (PMTCT)?

Appeared in: NORCET 9 Mains - 2025

Explanation

Current guidelines recommend lifelong combination antiretroviral therapy (cART) for all pregnant and breastfeeding women with HIV, a strategy known as 'Treat All' or 'Option B+'.
ART should be initiated as soon as possible in pregnancy (or continued if already on treatment) and maintained throughout pregnancy, labor, and postpartum.
The primary mechanism of prevention is the suppression of the maternal viral load to undetectable levels, which reduces the risk of transmission to the infant to less than 1-2%.
This comprehensive approach covers all potential transmission periods: in utero, intrapartum (during birth), and postpartum (through breastfeeding).

Option A: Starting ART only in the last trimester is an outdated and suboptimal strategy. It does not allow sufficient time to suppress the maternal viral load before the high-risk period of delivery.
Option B: This is an absolute statement that is no longer universally true. WHO guidelines recommend exclusive breastfeeding for mothers on suppressive ART in resource-limited settings, as the benefits outweigh the minimal transmission risk.
Option C: A Caesarean section reduces, but does not 'completely prevent' transmission. Transmission can still occur in utero, before the procedure.

Visual 1: Flowchart: Illustrating the WHO Option B+ protocol for PMTCT. This would show the timeline for initiating ART in the mother, continuing it for life, and the corresponding antiretroviral prophylaxis for the infant after birth.
Visual 2: Infographic: Comparing the risks and benefits of breastfeeding versus formula feeding for an HIV-positive mother on suppressive ART, highlighting the different recommendations for resource-rich and resource-limited settings.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Prevention of Mother-to-Child Transmission (PMTCT) of HIV as background academic context rather than a clinical decision trigger.
Nurses play a critical role in PMTCT by providing comprehensive counseling on ART adherence, discussing infant feeding options in a non-judgmental way, and ensuring the newborn receives timely prophylaxis.
Patient education is paramount. The nurse must explain that taking ART every day is the most important thing the mother can do to have a healthy, HIV-negative baby.
What if? If a pregnant woman presents in labor without having received any prior antenatal care or ART, she should be started on ART immediately (intrapartum), and the infant will require a more intensive, multi-drug 'presumptive HIV therapy' regimen for 6 weeks instead of simple prophylaxis.

How to Approach the Question

First, identify the core clinical question: What is the correct practice for preventing HIV transmission from mother to child?
Recall the current gold standard for PMTCT. The key principle is 'Treat All,' meaning all HIV-positive pregnant women should be on ART.
Analyze the timing aspect. Modern guidelines emphasize starting ART as early as possible and continuing it indefinitely.
Evaluate each option based on this principle. Option A (late start) is incorrect. Option B (absolute breastfeeding ban) is an oversimplification. Option C (complete prevention by C-section) is an inaccurate absolute claim.
Option D correctly reflects the principle of continuous and comprehensive ART throughout the entire pregnancy period, making it the best answer.

Concept Tested & Keywords

Concept Tested: Prevention of Mother-to-Child Transmission (PMTCT) of HIV
Stem keywords: HIV-positive mother, pregnancy, last trimester, prevention of mother-to-child transmission (PMTCT)
Lead-in keywords: correct statement
Clinical cues: The patient is an HIV-positive mother, which immediately brings PMTCT protocols into focus.
Negative lead-in flag: false

Q6V913f1aqihMYew4PNE9D

Practise the full NORCET 9 Mains - 2025

Attempt every question from this paper in a timed mock, then review the full solution for each one.