[Perinatal infection with the human immunodeficiency virus]

HIV infection, eventually resulting in AIDS, represents an important problem of the present days, whereas statistical parameters corresponding with the incidence of its manifestations and lethal outcome deserve great attention and cause anxieity of both general population and medical workers of all profiles. The problem is particularly complicated in the HIV-infected pregnant women. The aim of this paper is to examine epidemiology of HIV and AIDS, influence of HIV infection on the course and outcome of pregnancy, ways of transmission of HIV infection from mother to child, possible effects of progression of HIV infection and medical procedures and approaches in HIV-infected pregnant women.

Some studies from North America and Europe demonstrated an adverse effect of HIV-1 infection on pregnancy outcome, others failed to confirm these findings. Most studies from Africa describe an untoward effect of HIV-1 infection on pregnancy outcome, including fetal wastage, prematurity, low birth weight, stillbirth and neonatal death, but not in terms of embryopathy or congenital abnormalities. The incidence of perinatal transmission varies from 13% and 48%, 13% to 32% for the developed world and 25% to 48% for developing countries. Transmission can take place antepartum, during delivery and postpartum by breastfeeding. Transmission during the first trimester may take place but current data suggest that a substantial proportion of perinatal HIV-1 transmissions take place rather late in pregnancy or during delivery. The apparent absence of viral genome from fetal tissue, presence of a normal immune system at birth, absence of neonatal morbidity and reports of differential viral transmission in twins are arguments in favour of late transmission. One of the greatest concerns for both women and their physicians is the possibility that pregnancy may accelerate the onset of AIDS in mother. Pregnancy itself can be immunosupressive and some investigators have hypothesized that the cumulative immunosupressive effect of HIV-1 infection and pregnancy may accelerate the course of HIV-1 infection in pregnant women. Counselling of HIV-positive women worldwide in regard to their HIV serological status has not proved to influence most women's attitudes towards their subsequent reproductive behaviour.

HIV-infected women should be offered a possibility of an abortion. Ongoing pregnancies should be carefully monitored and CD4 lymphocyte subsets examined at booking. If the CD4 count is below 200 cells/mm, prophylaxis Pneumocystis carinii and Zidovudine therapy should be initiated. Prevention includes changes of behaviour such as reduction of the number of partners, condom use and early and appropriate treatment of sexually transmitted diseases. Antiviral therapy at birth may prevent this type of HIV-transmission. Also vaginal lavage with virus inactivating products such as chlorhexidine has to be assessed as a possible intervention. Prevention of phase 3 transmission (by breast milk) primarily involves recommendation for seropositive mothers not to breats feed their children. Contraceptives should be strongly advocated as soon as possible after giving birth.

HIV infection, reproduction and motherhood jeopardize millions of women worldwide. The most appropriate approach in preventing perinatal transmission involves preventing HIV-1 infection in women of childbearing age, including sexual education nd condom promotion at a very young age.