New Tests Would Help Lower Perinatal Transmission

Considering all that is known and unknown, I would advise a cesarean section for women whose viral load is greater than 1,000 copies/mL. When a patient's viral load is low, however, I would tell her that there is no proven benefit to delivering surgically.

Managing HIV in Pregnancy

When the HIV-AIDS epidemic spread across the Western hemisphere and into the United States, we all were petrified. We've made great strides with research and investigation. Today, we have a greater understanding of the biology of the disease, ways to prevent its transmission, and methods of control. Medication development has moved rapidly.

However, in concert with this good news, patients have become less anxious and, to some extent, have let their guards down. The scare factor seems to have decreased among women and their partners. As a consequence, the rapid decline in incidence that we had hoped for has not materialized.

The number of reported HIV cases in the United States now exceeds 1 million, and the Centers for Disease Control and Prevention estimates that about 25% of those living with HIV are unaware that they have the infection. Increasingly, women are at risk; the CDC reports that from 1999 to 2003, the estimate of AIDS cases increased by 15% among females and 1% among males.

Physicians will therefore continue to be confronted with women who are HIV infected. Like other women, these patients want to have children and provide for their families, so a thorough discussion of the management of HIV in pregnancy is most appropriate at this time. It is particularly important for obstetricians in urban areas, where the presentation of HIV-infected women can be higher. But it is also certainly important in suburban areas, which will see their share of pregnancies in HIV-infected women. Nobody is immune and no community is spared.

I am very pleased to have Howard L. Minkoff, M.D., as my Master Class guest professor this month. He is currently a distinguished professor of ob.gyn. at the State University of New York, and is chair of the department of ob.gyn. at Maimonides Medical Center, both in Brooklyn. Dr. Minkoff has done extensive research and has published widely on the topic of HIV in pregnancy.