Examination and investigations

HIV positive women should have a full physical examination at the first visit. Particular attention should be paid to any signs of HIV-related infections [particularly tuberculosis], oral or vaginal thrush, or lymphadenopathy. Herpes zoster [shingles] in a young woman is often an early sign of HIV infection and current herpes lesions or the scars from previous infection may be found. Other co-existent sexually transmitted infections, especially syphilis, are common in HIV positive women^{96,97,370,371} and may increase the risk of transmission and the level of virus in vaginal and cervical secretions. Clinical diagnosis and treatment of vaginal or cervical inflammation, abnormal discharge or STI should be a priority. The pregnant woman should be monitored for any signs of HIV-related opportunistic infections and for any other intercurrent infections, such as urinary or respiratory infection. Maternal weight should be monitored and nutritional supplementation advised where necessary. The oro-pharynx should be examined at each visit, for the presence of thrush.

Laboratory investigations will depend upon the available resources of the health service. Syphilis testing should be undertaken, and repeat testing in late pregnancy may be advisable⁴⁰. A haemoglobin estimation is mandatory and a complete blood count should be performed and T cell subset investigations undertaken where possible. Anaemia is more common in HIV-infected women and repeated haemoglobin tests may be helpful. Viral load estimation may provide a valuable prognostic indicator, where available. A cervical smear should be performed if this has not been undertaken within the recent past. Colposcopy should be reserved for women who have an abnormal cervical smear result.