HIV in Pregnancy: A Review (UNAIDS, 1999, 67 p.): SECTION A : HIV IN PREGNANCY: Susceptibility of women to HIV infection: Biological factors

HIV in Pregnancy: A Review (UNAIDS, 1999, 67 p.)

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EXECUTIVE SUMMARY

INTRODUCTION

SECTION A : HIV IN PREGNANCY

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Epidemiology of HIV

Susceptibility of women to HIV infection

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Biological factors

Socio-cultural factors

Effect of pregnancy on the natural history of HIV infection

Effect of HIV infection on pregnancy

Mother-to-child transmission

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Factors affecting mother-to-child transmission of HIV-1

Interventions to prevent mother-to-child transmission of HIV

Appropriate interventions to reduce mother-to-child transmission

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Antiretroviral therapy

Immune therapy

Nutritional interventions

Mode of delivery

Vaginal cleansing

Modification of infant feeding practice

Voluntary HIV counselling and testing in pregnancy

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Testing of antenatal women

Counselling before and after HIV testing in pregnancy

Counselling about pregnancy-related issues

SECTION B : MANAGEMENT OF HIV-POSITIVE PREGNANT WOMEN

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Antenatal care

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Obstetrical management

Examination and investigations

Medical treatment during pregnancy

Antiretroviral therapy

Care during labour and delivery

Postpartum care

Care of neonates

SECTION C : INFECTION CONTROL MEASURES

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Universal precautions

Risks of needlestick injuries

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Management of needlestick injuries and other accidental blood exposure

REFERENCES

Biological factors

The rate of transmission of HIV from male to female is two to three times higher than that from female to male^27,28. The Langerhans' cells of the cervix may provide a portal of entry for HIV and it has been suggested that some HIV serotypes may have higher affinity for these, and therefore to be more efficient in heterosexual transmission²⁹.

Vulval and vaginal inflammation or ulceration may facilitate entry of the virus. Sexually transmitted infections (STI) are common in many African countries, where HIV prevalence is also high^30,31,32. Inadequately treated or "silent" chlamydial and other sexually transmitted infections may act as co-factors for HIV infection and transmission^{33,34,35,36,37,38}. Syphilis rates as high as 30% have been described in antenatal women^39,40 and 4.2% of women in a population based study in the United Republic of Tanzania reported a history of genital ulceration⁴¹, which has been well established as a co-factor for HIV acquisition^42,43,44. In Zimbabwe, women reporting a history of genital ulceration and pelvic inflammatory disease were six times more likely to be HIV-positive⁴⁵. Improved STI treatment in a randomized controlled trial in the United Republic of Tanzania was shown to reduce the rate of new HIV infections⁴⁶. Other non-sexually transmitted cervical lesions, such as schistosomiasis, may also facilitate HIV infection⁴⁷. Although the evidence is still inconclusive, associations between oral and injectable contraceptive use and increased HIV risk have been reported^48,49.