Invited Commentary

Commentary on “Medical Care of Pregnant Women in Eastern North Carolina with Human Immunodeficiency Virus”

Authors: Mark R. Wallace, MD


Rimawi and colleagues are to be commended for drawing our attention to an easily overlooked but common flaw in our healthcare system—the failure to provide efficacious, low-tech services in a timely manner.1Their study, conducted in eastern North Carolina, found that in almost half of all pregnancies complicated by human immunodeficiency virus (HIV) infection, the infection was initially discovered at a prenatal visit rather than at preconception. Worse, even after the HIV infection was diagnosed, a considerable delay often occurred between diagnosis and the initiation of highly active antiretroviral therapy, and only 45% of the women went into labor with an undetectable viral load. Many unnecessary cesarean sections were performed as a result of this failure to achieve an undetectable viral load before delivery and five children were born infected with HIV.

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1. Pokharel S, Rimawi R, Siraj D. Medical care of pregnant women in eastern North Carolina with human immunodeficiency virus. South Med J 2013; 106: 196–200.
2. Smith EA, Jacques-Carroll L, Walker TY, et al. The national Perinatal Hepatitis B Prevention Program, 1994–2008. Pediatrics 2012; 129: 609–616.
3. Centers for Disease Control and Prevention. Vital signs: HIV prevention through care and treatment—United States. MMWR Morb Mortal Wkly Rep 2011; 60: 1618–1623.