HIV in Pregnancy: A Review

THIS PRESENTS A concise review of HIV in pregnancy, the management of HIV-positive pregnant women and infection control measures. It draws attention to the fact that most of the 33 million people living with HIV (human immunodeficiency virus) are in low- and middle-income countries, where HIV infection in pregnancy has become one of the most common complications of pregnancy in some countries. In Kenya, Malawi, Namibia, Rwanda, South Africa, Tanzania, Zambia and Zimbabwe, over 10 per cent of women attending antenatal clinics in urban areas are HIV-positive, with rates of almost 60 per cent in some areas. To date, Africa has had the highest prevalence of HIV, but a rapid rate of infection has been seen in Southeast Asia. Women are particularly susceptible to HIV infection for both biological and sociocultural reasons, and the proportion of infections in women is increasing in many countries.

Almost 600,000 children are infected by mother-to-child transmission of HIV each year. The report lists a number of interventions for reducing this transmission rate, including anti-retroviral therapy, immune therapy, nutritional interventions, mode of delivery, vaginal cleansing and modifications in infant-feeding practice. It draws attention to the benefits of HIV testing in pregnancy, bearing in mind that this must be balanced with the possible risks of stigmatization, discrimination and violence. It also highlights that the management of pregnancy in HIV-positive women should be seen as part of the holistic and long-term care of the woman, and that universal precautions against occupational exposure to HIV and other pathogens should be in place in all maternity services. In its final section, the report gives a set of guidelines for infection control and safe working conditions regarding HIV in pregnancy.