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Recent developments in HIV and women's health

^1. Nuffield Department of Obstetrics and Gynaecology, Women's Centre, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK brenda.kelly{at}obs-gyn.ox.ac.uk (corresponding author)
^2. Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford, UK
^3. Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford, UK

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.

Keywords cervical intraepithelial neoplasia (CIN) / highly active antiretroviral therapy (HAART) / HIV / pregnancy / reproductive health