Assessing the timing and delivery methods, clinical and laboratory indicators of HIV-infected pregnant women is important for organizing effective care for this group of patients and further reducing the frequency of perinatal transmission of HIV infection. In 20142017, in Saint Petersburg, there were 2,524 childbirths in HIV-infected women, who were observed during pregnancy mainly in the Center for the Prevention and Control of AIDS and Infectious Diseases (AIDS Center). The average frequency of perinatal HIV transmission in the city over the study period was 1.3%, which is lower than the average for Russia (2.5%). A retrospective and prospective analysis of 1,858 medical records of HIV-infected women observed during pregnancy at the AIDS Center in 20142017 was performed. An annual decrease in the proportion of chronic viral hepatitis C coinfection was found, which was proportional to a decrease in parenteral HIV transmission in the study group. Due to the increase in HIV testing coverage, the frequency of detection of infections in pregnant women in antenatal clinics during registration was reduced. This allows conducting a thorough examination, counseling and a timely initiation of antiretroviral therapy (ART) during pregnancy planning. The vast majority of HIV-infected women are committed to follow-up in medical facilities during pregnancy, to receive antiretroviral prophylaxis (ARP) and, as a result, to give birth to a healthy child. The rate of preterm birth among HIV-infected women is higher than in HIV-seronegative women. This determines the timely initiation of ARP/ART during pregnancy for prevention of preterm delivery. The proportion of births through the birth canal increases annually, but the operative delivery rate remains above the population.

Despite the success in reducing mother-to-child HIV transmission rate worldwide, the problem of perinatal HIV transmission is still relevant. Sexual activity nowadays is the predominant way of transmission, therefore the number of HIV cases among women growths. This leads to an increased number of pregnancies and childbirth in HIV-infected women. Better preventive treatment has decreased the transmission risk to 1% or less. Despite this, the Russian Federation is still not among the countries where the elimination of mother-to-child transmission has been recorded. This review article focuses on the main stages of mother-to-child transmission prevention from the time that no antiretroviral therapy was available to the current stage, when highly active antiretroviral therapy is used during pregnancy, childbirth and for the treatment of newborns. The research provides a comparative analysis of modern national and international clinical recommendations for the prevention of mother-to-child HIV transmission.

HIV-infected women have a higher risk of complications during pregnancy and delivery (chronic placental insufficiency, anemia, placental abruption, preterm birth) compared with HIV-negative women, especially in case of opportunistic infections, immunodeficiency and a high viral load in the blood. The obstetrical pathologies are hard to study in these women because the above conditions are associated with a range of confounding factors that are not directly related to HIV infection but are often present, such as drug addiction, weight deficit, and chronic viral hepatitis coinfection. The literature review provides data from domestic and international studies on the correlation between HIV infection and the frequency of complications during pregnancy, delivery and the postpartum period, as well as the effect of the infection on the condition of newborns. The article cites current recommendations on the choice of delivery types for HIV-infected women.