Effects of HIV infection on pregnancy. A clinical and immunologic evaluation

To understand better the effects of HIV infection on pregnancy, a group of 16 HIV seropositive pregnant patients was evaluated prospectively. Complications and results of pregnancy in these individuals were compared with those of 1,906 births at Charity Hospital, New Orleans during the time of the study. A subgroup of five patients underwent immunologic testing prenatally and postpartum. Thirty-one percent of HIV seropositive subjects had premature labor and low birth weight infants. Only 3.1% of the controls had premature labor and low birth weight infants (p less than or equal to .05). The percentage of C-sections was lower in the study group (12.5% versus 31.3%, p less than .10). All patients remained free of HIV-related disease through the postpartum period. Mean CD4 percentages were lower postpartum (21.9 +/- 3.4) than prepartum (45.1 +/- 6.7) in all five patients studied, although proliferative responses to the mitogens phytohemagglutinin and pokeweed were unchanged during the study period. One of the five seropositive patients who underwent immunologic testing with a CD4:CD8 ratio of less than 1.0 prepartum, had a progressive fall in CD4 percentages from 30% to 11% during the course of the study. HIV-I core antigen was not detected in the serum of any of the five patients during pregnancy or postpartum. Thus, HIV-I infection influenced both the course and outcome of pregnancy in the population studied. Further studies are indicated to assess the effects of pregnancy on the progression of HIV-related immunodeficiency in this population.