[AIDS and perinatal aspects]

The proportion of women among AIDS. patients in Europe is progressively rising. The male-to-female sex ratio had constantly decreased from 11.7% through 1984 (17 countries) to 5 in 1990 (31 countries). The proportion of female cases is greatest in Southern Europe, France and Belgium. This is related to the predominant transmission factors, homosexual in Northern Europe, IV drug use in Southern Europe and heterosexual in Belgium. In France, IV drug use predominates in the South, whereas heterosexual transmission is more frequent in the Paris area. Pregnancy does not appear to accelerate disease progression, except in women with symptomatic infection or low CD4 counts. Over 80% of infant AIDS cases are related to mother-to-child transmission. The rate of transmission is about 20%, higher in patients in advanced disease stages. A number of questions remain open. At what time in pregnancy, early gestation, late gestation and/or during labor, does transmission occur? Is the only mechanism of transmission transplacental, or can it also occur during delivery? Does placental transfer concern free virus, immune complexes and/or intracellular virus? Management of pregnancies with HIV infection concerns the entire European community. In France, pregnancy is discouraged among HIV-seropositive women. However, more than 1,500 do become pregnant each year. Testing is recommended at the first prenatal visit for all women, and repeated regularly for seronegative women with HIV-infected partners. Preconceptional testing should be proposed whenever possible. The decision whether to continue or to terminate pregnancy is a woman's choice. Complete information and counseling must take into account the patient's disease status.(ABSTRACT TRUNCATED AT 250 WORDS)