Care for pregnant women with HIV has evolved over the last several decades, largely owing to combination antiretroviral therapy (cARV) leading to decreased morbidity and mortality in the context of a diagnosis of HIV (Severe P, et al. NEJM 2016;363(3):257–265; INSIGHT START study group. NEJM 2015;373:795–807). This has led to steadily increasing numbers of women with HIV becoming pregnant. Historically, obstetricians were taught to avoid invasive procedures and rupture of membranes, give intravenous zidovudine in labour and recommend caesarean delivery. However, the growing body of contemporary literature refutes these management trends when a pregnant woman is on antiretroviral therapy with an undetectable viral load. In this issue of BJOG, Floridia et al. evaluate the rates of mother-to-child transmission of HIV with amniocentesis and chorionic villus sampling (CVS). This is a multicentre trial running from 2001 to 2015, containing 113 HIV-positive pregnant women who underwent invasive testing. The majority (87.6%) were on antiretroviral therapy, and none of the infants born to women on cARV therapy at the time of amniocentesis or CVS became HIV positive. Of the two cases of HIV transmission in this series, one was diagnosed with HIV late in her pregnancy after the invasive procedure, and the other was only receiving zidovudine monotherapy at the time of her procedure with an elevated viral load. Unfortunately, the authors do not provide information about the viral loads at the time of the procedures, nor the timing of infant HIV transmission (in utero versus intrapartum). While the number of HIV-positive women on cARV undergoing invasive procedures is one of the highest reported in the literature, it is underpowered to detect small increased risks of HIV transmission involved with these procedures. Importantly, one of the cases of neonatal HIV transmission occurred in a women with a negative first-trimester HIV test, who was then diagnosed with HIV later in pregnancy. This highlights the importance of prompt diagnosis and treatment of HIV, in order to reduce mother-to-child transmission. While many pregnant women with HIV are on cARV therapy, recent literature has been illustrating a disproportionate number of cases of mother-to-child transmission occurring in women with delayed diagnosis or therapy (Birkhead GS et al. Obstet Gynecol 2010;115:1247–55; Lu D, et al. Can J Public Health 2014;105:e47–52). The article by Floridia et al. provides valuable information to aid counselling pregnant women with HIV undergoing genetic testing and considering invasive procedures. We are moving into an era where pregnant women with HIV are able to weigh the risks of conditions such as aneuploidy against mother-to-child transmission of HIV, and studies such as these give physicians the ability to give evidence-based recommendations to assist in these decisions. None declared. Completed disclosure of interests form available to view online as supporting information. ■ Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.