No abstract

The rate of virologic failure in this unselected group of patients was higher than that observed in randomized clinical trials, but only a minority (11%) of the patients were treatment naïve. Starting combination therapy simultaneously and initiating antiretroviral therapy before advanced HIV disease has developed predict virologic response, whereas the magnitude of viral suppression predicts mid to long immunological response.

Contribution of acquired immunodeficiency syndrome/human immunodeficiency virus (HIV) infection to pregnancy mortality rates is difficult to estimate; however, it appears to be one of the leading causes of death, at least in developing countries. Prenatal HIV testing affords the best opportunity for the prevention of perinatal HIV transmission. Rapid HIV testing substantially increases the proportion of women who obtain HIV results compared with conventional enzyme-linked immunosorbent assay testing, thus maximizing perinatal HIV interventions. Pregnancy appears to have no effect on the course of HIV disease. Infections due to a variety of pathogens influence the clinical course of the HIV infection and may complicate pregnancy and increase maternal mortality. The main risk factors for mother-to-child HIV transmission are high maternal viral load and CD4 cell count <700 cells/mm3. The main protective factor is antiretroviral therapy.

International guidelines recommend resistance testing of maternal virus for all human immunodeficiency virus (HIV)-infected pregnant women. The use of highly active antiretroviral therapy leads to maximal virologic suppression, thus minimizing the risk of drug resistance, but it is available only in developed countries. In developing countries, the use of short-course regimens is becoming more widespread. Women infected with HIV may be at greater risk for complications during pregnancy, including ectopic pregnancy, early abortions, bacterial pneumonia, urinary tract infection, oral and recurrent vaginal thrush, malaria, and tuberculosis. Regional anesthesia is often the treatment of choice when administering anesthesia in an HIV-infected pregnant woman. Infected children present decreased survival rates, while uninfected children born to infected mothers present a higher incidence of poor weight gain, short stature, and wasting than would be expected for the general population. Transmission of HIV-1 can occur via breast-feeding.