Human Immunodeficiency Virus and Reproduction

Abstract

HIV and AIDS increasingly plague women throughout the world. Female infection and mortality are staggering in parts of sub-Saharan Africa and rising in the Americas and parts of western Europe. In the urban centers of these regions, the World Health Organization estimates AIDS is the leading cause of death for reproductive age women. Worldwide, an estimated 150,000 women developed AIDS over the 1980s, and 2 million were infected by 1990. While women may be infected with and spread HIV through sexual contact or direct systemic exchange with infected blood, women's ability to transmit HIV perinatally poses an additional threat to infant and child health and society at large. Over 80% of pediatric AIDS cases are due to perinatal transmission, with an estimated total of 200,000 infants infected thus far worldwide. Perinatal AIDS is estimated to have increased infant and child mortality by 30%. In acknowledgement of this excess mortality and the possible contribution of pregnancy to the spread of HIV infection, screening for HIV seropositivity at prenatal clinics has increased. This paper discusses the impact of HIV infection on perinatal outcome, maternal-infant HIV transmission, perinatal AIDS, diagnosis of perinatal HIV infection, time and mechanism of vertical transmission, horizontal transmission, and the rate of maternal-infant transmission. The evaluation, counseling, treatment, prenatal diagnosis, delivery management, risk of professional contamination, and postnatal care elements of managing pregnancy in HIV-seropositive women are also considered. Finally, sections discuss reproduction issues and nonpregnant HIV-infected women, seronegative women with HIV-infected partners, and prevention.