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\begin{document}

\title{Caesarean section trends among 48 688 women living with and without HIV
in Brazil: a cohort study}



\author[1]{Lanbo Yang}%
\author[2]{Mary Catherine Cambou}%
\author[3]{Eddy  Segura}%
\author[4]{Marineide Gonçalves de Melo}%
\author[4]{Breno  Santos}%
\author[4]{Ivana Rosângela dos Santos Varella}%
\author[2]{Karin Nielsen-Saines}%
\affil[1]{Brown University}%
\affil[2]{David Geffen School of Medicine}%
\affil[3]{Universidad de Huanuco}%
\affil[4]{Hospital Nossa Senhora da Conceição}%


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  \date{June 18, 2024}


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\begin{abstract}
Objective: To evaluate caesarean section (CS) rates in women with and
without HIV and frequency of mother-to-child HIV transmission. Design:
Retrospective cohort study. Setting: Tertiary hospital in south Brazil,
epicenter of the country's HIV epidemic. Population or Sample:
Women-infant pairs delivering at one institution between 1/1/2008 to
12/31/2018 Methods: Data was extracted from hospital records CS
frequencies were compared using Pearson's chi-squared test. CS
predictors were evaluated by multivariate log-linear Poisson regression
using a generalized estimating equations approach. HIV viral suppression
(VS) was defined as virus load (VL) of \textless{}1000 copies/ml at
delivery. HIV MTCT was determined according to national guidelines. Main
Outcome Measures: C-section, HIV mother-to-child transmission (MTCT).
Results: Over 11 years, 48,688 pregnancies occurred in 40,375 women; HIV
seroprevalence was 2.7\%; 18,886 (38.8\%) CS were performed; 47.7\% of
WLH and 38.6\% of women without HIV (WWOH) had CS, p\textless{}0.001.
Although HIV was a risk factor for CS (aRR: 1.17 {[}1.05-1.29{]}), WLH
with VS achieved similar CS rates (36.7\%) as WWOH (39.8\%) by 2018. CS
in WLH with unknown VL at delivery (42.6\%) did not increase over time.
HIV MTCT rate was 2.2\%, highest in WLH with unknown VL (8.4\%) versus
WLH without VS (4.1\%) and WLH with VS (0.5\%; p\textless{}0.001).
Conclusion: In the HIV epicenter of Brazil, WLH with VS had less
surgical deliveries, likely due to potent combination antiretroviral
use. Nearly half of WLH with unknown VL, did not undergo CS, a potential
missed opportunity for HIV PMTCT.%
\end{abstract}%



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