Medical Council of Canada Qualifying Examination Part 1 Exam MCCQE Question # 65 Topic 7 Discussion
MCCQE Exam Topic 7 Question 65 Discussion:
Question #: 65
Topic #: 7
A 26-year-old woman, gravida 1, para 0, aborta 0, consults you at 36 weeks’ gestation regarding newborn care. She has HIV. Which one of the following is the best advice regarding reducing the risk for transmission of HIV to her newborn?
A.
Bottle-feed her newborn boiled expressed breast milk.
B.
Avoid kissing her newborn.
C.
Formula-feed her newborn.
D.
Bottle-feed her newborn expressed breast milk.
E.
Breastfeed her newborn during the colostrum period only.
In Canada and other high-resource settings where safe alternatives are readily available, women living with HIV are advised to exclusively formula-feed their infants to eliminate the risk of postnatal HIV transmission through breast milk. HIV can be transmitted during pregnancy, delivery, and breastfeeding. While effective maternal combination antiretroviral therapy and neonatal prophylaxis significantly reduce perinatal transmission risk, breastfeeding still carries a residual risk because HIV is present in breast milk. Boiling expressed breast milk is not recommended as a standard preventive strategy in high-resource settings. Avoiding kissing is unnecessary, as casual contact does not transmit HIV. Breastfeeding only during the colostrum period does not eliminate transmission risk. According to MCCQE objectives, physicians must provide evidence-based counseling regarding prevention of vertical transmission, including maternal antiretroviral therapy, appropriate mode of delivery when indicated, neonatal prophylaxis, and avoidance of breastfeeding when safe formula feeding is accessible. Clear counseling supports informed decision-making and optimal neonatal outcomes.
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