During her first antepartal visit, a patient who is at 10 weeks' gestation reports that she is HIV-positive. Which statement made by the patient indicates an understanding of the plan of care both during the pregnancy and postpartally?
1. "I'm supposed to take highly active antiretroviral therapy (HAART), but only during the first trimester."
2. "I should not breastfeed my baby."
3. "If I have a cesarean section, there's an increased risk that my HIV will be passed to my baby."
4. "When my baby is 2 months old, he or she will be tested for HIV."
Correct Answer: 2
Rationale 1: Longer duration therapy is preferable to shorter duration approaches, and it is best to start prophylaxis after the first trimester and no later than 28 weeks' gestation in women who do not require immediate therapy for their own health.
Rationale 2: HIV transmission can occur during pregnancy and through breast milk; however, it is believed that the majority of all infections occur during labor and birth.
Rationale 3: Cesarean section reduces the transmission of HIV from mother to infant.
Rationale 4: Following birth, HIV infection in infants should be diagnosed using HIV virologic assays as soon as possible, with initiation of infant antiretroviral prophylaxis immediately if the test is positive.
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