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Chapter 13 : Human Immunodeficiency Virus Infection and Pregnancy
Category: Bacterial Pathogenesis; General Interest
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This chapter familiarizes clinicians with the literature regarding outcomes of pregnancies of human immunodeficiency virus (HIV)-infected women, and describes strategies to minimize transmission and to reduce the frequency of adverse perinatal outcomes. Pregnant women with a high viral load, revealed by high titers of HIV or p24 antigenemia, apparently are a group at particularly high risk of transmission. Acute viremia associated with maternal seroconversion in the year prior to pregnancy or during breast-feeding appears to be associated with increased rates of vertical transmission. Intensive exposure of the infant’s thin skin or mucosal surfaces to maternal blood and secretions during the birth process could provide a significant route for virus transmission. Advanced immunologic deterioration, as demonstrated by decreased numbers of circulating CD4+ lymphocytes, has been associated with an increased risk of vertical transmission. Over the last several years, a great deal has been learned about the timing of transmission. There are no data to support antepartum, intrapartum, and neonatal (breast-feeding) transmission of HIV. Most reports from developed countries suggest that, other than transmission of HIV infection, pregnancy outcomes are not affected by serostatus, at least in asymptomatic patients. Women who choose to maintain their pregnancy should be aware that certain interventions may reduce the risk of perinatal HIV transmission and that several other approaches are under study to determine whether they will have additional benefit. The single most important step in prenatal care today is the use of zidovudine (ZDV) in the antepartum, intrapartum, and neonatal periods.