Recent developments in HIV and women's health

Key content • In the UK, the proportion of HIV-positive pregnant women diagnosed before delivery is around 95%. • The benefits of highly active antiretroviral therapy (HAART) in reducing mother-to-child transmission are undisputed; however, there are potentially adverse effects on maternal and fetal/neonatal health. • Vaginal delivery may be considered for HIV-positive pregnant women with undetectable viral loads who are on HAART. • Hormonal contraception can be affected by drug–drug interactions with HAART or nonantiretroviral medication that HIV-positive women may be taking. • Although HAART can alter the natural history of cervical intraepithelial neoplasia (CIN), annual cervical cytology is still recommended. Learning objectives • To be aware of the different types of HAART, their use and associated maternal, fetal and neonatal toxicities. • To be able to critically evaluate the place of prelabour elective caesarean section in light of recent developments in viral load testing and HAART. • To be aware of potential drug–drug interactions that can reduce the efficacy of hormonal contraception in HIV-positive women. • To appreciate the potential impact of HAART and the recently developed human papillomavirus vaccines on the natural history of CIN in HIV-positive women. • To know where to find up-to-date information on drug–drug interactions and clinical vaccine trials relating to HIV. Ethical issues • Clear communication about the potential risks and benefits of strategies to reduce mother-to-child transmission is critical to enable HIV-positive pregnant women to reach informed decisions about their care. Please cite this article as: Kelly B, Morrison J, Hurley P. Recent developments in HIV and women's health. The Obstetrician & Gynaecologist 2008;10:42–48.