Elective cesarean sections prior to rupture of membranes can reduce MTCT in HIV-positive women who are not receiving ART.^124,125 For women receiving ART, however, cesarean sections do not decrease the risk of MTCT. Recent data from PACTG 367 indicate that transmission rates are significantly lower when multi-agent therapy is being administered and when lower maternal plasma HIV RNA levels are observed; rates do not differ significantly according to mode of delivery.¹²⁶ Cesarean sections should therefore be reserved for women who are likely to have a detectable viral load at the time of labor—that is, those women who are not receiving effective ART or who demonstrate nonadherence during pregnancy—and women who have an obstetric indication for a cesarean section. This stipulation is particularly important given that women with HIV infection may be at increased risk of febrile complications after a cesarean section.^127,128