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INTRODUCTION

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Despite all we have learned about the HIV virus, HIV infection continues to ravage the world, particularly in underdeveloped nations. The United Nations estimates that worldwide over 35 million people are infected with the HIV virus and 16,000 new infections occur each day. In the United States, over 50,000 new infections occur each year. In 2011, 21% of the new diagnosis—almost 10,000 cases of HIV infection occurred in women and adolescent girls. The Centers for Disease Control (CDC) estimates there are over 250,000 women in the United States who are HIV positive and 15% are unaware of their infection. The epidemic continues to disproportionately affect women of color. The rate of HIV infection in African American women is 20 times that of Caucasians while the rate of Latina women is 4 times as high as white women. See Fig. 26-1.

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FIGURE 26-1.

New HIV infections by gender and race/ethnicity.

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The care of HIV-infected pregnant women is more complex today than ever and pregnant women who are infected with the HIV virus present a challenge to even the most experienced clinician. Drug therapies have increased exponentially since the epidemic was first recognized. Obstetricians caring for HIV-infected women should only manage them in concert with clinicians who are fluent with current recommendation regarding drug therapies. A team experienced in the medical, obstetrical, and psychosocial needs of these women should manage HIV-infected patients.

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It is important to remember that HIV seropositivity is not synonymous with AIDS. This is especially true today, as current HIV drug regimens have allowed many HIV seropositive patients to survive free from an AIDS-defining condition. During the early period of the epidemic, most obstetricians had no experience treating an HIV-infected pregnant woman but with the dramatic increase in HIV infections in women, more and more obstetricians can expect to have an HIV-infected pregnant woman among their patients. The CDC estimates that women account for 25% of the more than 50,000 new cases of HIV infection acquired annually in the United States.

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The vast majority of infected women are of reproductive age and overwhelmingly acquire HIV infection from high-risk heterosexual contact. HIV infection is among the top 10 leading causes of death for African American women ages 15 to 64 and Hispanic women ages 25 to 44. However, the good news is that the majority of HIV-infected patients who receive appropriate antiretroviral therapy can expect a much longer and healthier survival than those infected early in the epidemic. HIV infections have decreased in African American women. Likewise, the use of antiretroviral drugs during pregnancy has drastically reduced the risk of perinatal transmission of HIV (Fig. 26-2).

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FIGURE 26-2.

Rates of perinatally acquired HIV infection by race/ethnicity.

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PATHOGENESIS

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