Although coexistent HIV infection and pregnancy are still rare in most communities, as the prevalence of HIV and AIDS continues to rise, the practicing physician can expect to see this more frequently. The internist plays a crucial role in educating these patients as to the importance of "safe sex" practices and pregnancy prevention. As with any complex medical problem, once pregnant, these patients are best managed with a team approach, involving the obstetrician, internist, neonatologist, and social worker.
PIP: Perinatal transmission of human immunodeficiency virus (HIV) has become an important mode of acquisition, which results in the birth of severely ill infants who succumb early to their disease and who often are abandoned in the hospital nursery for the duration of their short lifetime. Consequently, prevention of perinatal transmission is a primary goal. Several recent studies of the seroprevalence of HIV in pregnant women have shown high rates of infection. Landesman et al. report a seroprevalence of 2% when cord blood samples were tested in a blinded fashion in an inner city municipal hospital in Brooklyn, New York. At this time, there is no evidence that HIV infection or Acquired Immune Deficiency Syndrome (AIDS) adversely affects fertility. Perinatal transmission of HIV infection occurs in 33-50% of affected pregnancies. Circumstantial evidence suggest that pregnancy adversely affects the course of disease. Once pregnancy is diagnosed, the patient should be counseled, and abortion and sterilization services should be offered. A table identifies the numerous arguments both in support of and against the routine screening of pregnant women.