The Comment by Anna Coutsoudis and colleagues questions the Option B+ approach of preventing mother-to-child transmission (PMTCT) of HIV. In criticising this test-and-treat approach as "extreme", Coutsoudis and colleagues do not recognise that US guidelines already recommend treatment for all people irrespective of CD4 count, and that global guidelines recommend test and treat for certain subpopulations (ie, those with HIV and tuberculosis co-infection). Globally, mounting evidence supports Option B+ as the next step in the expansion of treatment as a combination prevention intervention that prevents HIV transmission to infants, minimises transmission to uninfected sexual partners,2 averts orphanhood, and protects maternal health.
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