HIV-1 infection in gynecology and obstetric [HIV in gynakologie und geburtshilfe]

HIV infected women have an increased morbidity caused by acute and chronic urogenital infections and their sequels. Up to 2/3 of the patients develop symptoms of genital infections and in around 1/3 cervical neoplasia is diagnosed. In 1/4 chronic lower abdominal discomfort and late sequels of PID will arise. Although cervical carcinoma (- 5%) fulfills already the AIDS definition, it manifests usually early in the course of the HIV disease and is rarely associated with other opportunistic diseases. Increased disturbances of menstruation like amenorrhoea (17%) or hypermenorrhoea has been observed. Major complication of pregnancy are preterm labor (- 15 %) and preterm delivery. An increased progression of the maternal HIV disease in association with pregnancy has not been observed. Risks of perinatal HIV-1 infection of the fetus are associated either with an already advanced or progressing HIV infection of the mother indicated by high vital load, p24 antigenemia and low CD4+ cells or obstetrical events like preterm delivery, preterm labor, amnionitis, duration of rupture of membranes and labor and contamination of amniotic fluid with maternal blood. Maternofetal HIV-1 transmission can be reduced by antiretroviral prophylaxis of the mother and the fetus (6-8 %), by elective caesarian (4-6 %) or most successfully by elective caesarian and antiretroviral prophylaxis (< 2%).