# Prevention of Mother-to-Child Transmission of HIV > Prevention of mother-to-child transmission of HIV for NEET-PG Medicine, with antenatal ART, delivery planning, infant prophylaxis and feeding counselling. - Canonical URL: https://prepelephant.com/topics/neet-pg/medicine/prevention-of-mother-to-child-transmission-of-hiv - Exam / course: NEET-PG · Subject: Medicine - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-14 - Last updated: 2026-10-14 - Reference basis: NACO National Guidelines for HIV Care and Treatment; Harrison's Principles of Internal Medicine - How to cite: "Prevention of Mother-to-Child Transmission of HIV", PrepElephant, https://prepelephant.com/topics/neet-pg/medicine/prevention-of-mother-to-child-transmission-of-hiv ## Direct answer Prevention of mother-to-child transmission of HIV is a combined strategy of lifelong antenatal antiretroviral therapy, planned delivery, infant prophylaxis and infant feeding counselling. Transmission is most likely around delivery and during breastfeeding, and sustained suppression of the maternal viral load sharply reduces the risk to the infant. In India the programme is delivered as PPTCT under NACO. ## What you must remember - **Lifelong ART:** all pregnant and breastfeeding women with HIV start ART regardless of CD4 count, and this is the single most important intervention. - **Viral load target:** the aim is a suppressed maternal viral load (below 1000 copies per ml); NACO tests it at 32 to 36 weeks to classify the infant as low or high risk. - **Delivery planning:** under NACO 2021, normal vaginal delivery is the norm and caesarean section is done for obstetric indications; elective caesarean at about 38 weeks for a viral load above 1000 copies per ml is an international (ACOG/DHHS) recommendation. - **Intrapartum care:** ART continues through labour, with minimal vaginal examinations and no artificial rupture of membranes. - **Infant prophylaxis:** under NACO 2021, a low-risk infant (maternal viral load below 1000 copies per ml after 32 weeks) gets nevirapine for 6 weeks; a high-risk infant gets nevirapine plus zidovudine for 6 weeks if replacement fed or 12 weeks if breastfed. - **Feeding:** NACO recommends exclusive breastfeeding for 6 months with maternal ART as the preferred option, with exclusive replacement feeding as an informed alternative; the older WHO AFASS framework is still asked in exams. - **Infant diagnosis:** nucleic acid testing at about 6 weeks, because maternal antibodies make antibody tests unreliable in exposed infants. ## From antenatal care to the first six weeks The sequence below follows a pregnancy from the first antenatal visit through delivery and early infant care. 1. **Antenatal testing:** test every pregnant woman early, start lifelong ART if she is HIV-positive, and monitor viral load with the aim of suppression well before delivery. 2. **Late pregnancy:** check the viral load at 32 to 36 weeks, since an unsuppressed level makes the infant high risk and changes the newborn's prophylaxis. 3. **Delivery:** in India vaginal delivery is planned with safe delivery practice and caesarean section is reserved for obstetric indications, whereas international guidelines add elective caesarean at about 38 weeks for a viral load above 1000 copies per ml. 4. **Newborn:** antiretroviral prophylaxis starts at birth, as single-drug nevirapine for 6 weeks if low risk, or dual prophylaxis for 6 or 12 weeks if high risk. 5. **Feeding:** counsel the mother on exclusive breastfeeding with maternal ART, discuss replacement feeding as an informed alternative, and avoid mixed feeding. 6. **Testing and cotrimoxazole:** nucleic acid testing at about 6 weeks and cotrimoxazole prophylaxis for exposed infants continue until HIV infection is excluded. ## Where the exam tries to catch you Examiners test whether the student delays ART, forbids breastfeeding or uses an antibody test in an infant. - **Trap:** start ART only after the CD4 count falls below a set threshold in pregnancy — **Correct:** pregnant and breastfeeding women start ART regardless of CD4 count, since prevention depends on viral suppression. - **Trap:** breastfeeding is always forbidden for a mother with HIV — **Correct:** breastfeeding with maternal ART is recommended, and replacement feeding is an informed alternative, and mixed feeding is avoided. - **Trap:** antibody testing confirms HIV infection in a 3-month-old exposed infant — **Correct:** maternal antibodies cross the placenta, so early infant diagnosis uses nucleic acid testing. ## Frequently asked questions ### What is the most effective intervention in preventing mother-to-child transmission of HIV? Lifelong antiretroviral therapy for the pregnant woman is the most effective intervention in preventing mother-to-child transmission of HIV. Suppressing the maternal viral load sharply reduces the risk to the infant, and ART is started regardless of CD4 count. ### When is elective caesarean section considered in prevention of mother-to-child transmission of HIV? Under NACO 2021, normal vaginal delivery is the norm in India and caesarean section is done for obstetric indications. International guidelines (ACOG, DHHS) consider elective caesarean at about 38 weeks when the viral load is above 1000 copies per ml near delivery. ### Why is nucleic acid testing used to diagnose HIV in exposed infants? Nucleic acid testing is used because maternal HIV antibodies cross the placenta and persist in the infant for up to about 18 months, making antibody tests unreliable. Early infant diagnosis is usually done at about 6 weeks of age. ### Can a mother with HIV breastfeed her baby in India? Exclusive breastfeeding for the first 6 months with maternal antiretroviral therapy and infant prophylaxis is the preferred option in India, in line with WHO guidance. Exclusive replacement feeding is an informed alternative, and mixed feeding is avoided. ### What prophylaxis do infants born to mothers with HIV receive? Under NACO 2021, low-risk infants receive nevirapine for 6 weeks, and high-risk infants receive nevirapine plus zidovudine for 6 weeks if replacement fed or 12 weeks if breastfed. Exposed infants also receive cotrimoxazole prophylaxis until HIV infection is excluded.