To reduce the risk of perinatal transmission of HIV in a patient with a viral load greater than 1000 copies/mL, which delivery method is recommended?

In cases where a pregnant individual has a high viral load of greater than 1000 copies/mL at the time of delivery, the recommended method to reduce the risk of perinatal transmission of HIV is a cesarean section performed before the onset of labor. This is primarily because the risk of HIV transmission to the newborn can increase significantly during vaginal delivery, particularly when the mother's viral load is elevated.

A planned cesarean section is advantageous in this scenario because it avoids the potential exposure of the infant to HIV-infected maternal blood, especially during vaginal delivery when there can be significant blood exposure if the membranes have ruptured or if there is any trauma during the delivery process.

Other methods like vaginal delivery carry a higher risk of transmission with an elevated viral load, cervical suturing does not address the delivery method itself, and vacuum extraction delivery can also pose risks similar to vaginal delivery. Therefore, opting for a cesarean section before labor onset is a strategic approach to enhance the safety and health of the newborn in the context of maternal HIV.