Human immunodeficiency virus disease in pregnancy.

Since the early 1990s, the number of women diagnosed with the human immunodeficiency virus (HIV) has exploded. Heterosexual women have become one of the fastest-growing populations of newly diagnosed cases. However, the full impact of HIV infection and acquired immunodeficiency syndrome (AIDS) on women's health and the optimal management of symptomatic and asymptomatic cases have yet to be delineated. The urgency to establish effective management protocols is underscored by the fact that AIDS has recently become the leading cause of death for minority women in many urban areas. The administration of antepartum and intrapartum zidovudine (azidothymidine, AZT) has advanced efforts to minimize perinatal transmission and produced promising results. However, important issues pertaining to prevention of HIV infection in women, mandatory testing of women of reproductive age, and the management of HIV-positive women during the interconceptional period remain controversial. Addressing HIV throughout the continuum of reproductive health is a major priority and a concern of all health care providers. Women's health care must assume the lead in counseling all women about their risk of HIV, ensuring that HIV-positive women make informed decisions about their reproductive health and that HIV-negative women modify high-risk behavior to avoid becoming infected. Since obstetricians and gynecologists, nurse practitioners, and midwives are often the first care providers whom at-risk and HIV-infected women contact, they must be able to identify, assess, and optimally manage these patients. This article reviews the epidemiology, virology, pathology, preconceptional counseling/testing, and management of women with HIV infection in pregnancy, thereby providing the practitioner with information and tools to enhance women's health.