HIV-infected pregnant women and their infants. Primary health care implications.

Human immunodeficiency virus infection in women and infants is a significant and growing health care problem in the United States. Young adult black or Hispanic women are at particular risk, especially if they use intravenous drugs or are the sexual partner of someone who does. However, acquired immunodeficiency syndrome/HIV infection is a significant cause of mortality in women of reproductive age (i.e., 15 to 44 years). In addition, the incidence of AIDS in infants directly correlates to the incidence of AIDS in childbearing women. HIV-infected pregnant women need on-going comprehensive prenatal care with a special focus on HIV management. Antepartum care should include an HIV-focused history and physical examination, as well as additional laboratory assessments to screen for viral and bacterial infections. Intrapartum care should focus on avoiding contact with infected or potentially infected secretions and body fluids. Postpartum care should emphasize development of a comprehensive and integrative plan of care for mother, baby and family unit prior to discharge. Avoidance of breastfeeding and strategies to prevent further HIV transmission must be stressed.