HIV infection in women: perinatal issues and cervical cancer surveillance.

Issues of HIV infection in women include perinatal care to prevent mother-child transmission and screening for cervical dysplasia. Antiretroviral therapy has been very successful in reducing perinatal transmission rates. Ongoing issues in this setting include absense of relevant pharmacokinetics data for new drugs and formulations, implementation of new resistance testing guidelines, and recent apparently conflicting findings on the potential role of protease inhibitor treatment in preterm delivery. Recent findings also include a similar low transmission rate with vaginal delivery and emergency cesarean delivery versus elective cesarean delivery in women on antiretroviral therapy with HIV viral load of less than 1000 copies/mL, and a low rate of postpartum morbidity in women undergoing elective cesarean delivery. Recent changes in recommendations for cervical cancer screening in the general population should not be applied to HIV-infected women. However, the recent finding that HIV-infected women with CD4+ cell counts greater than 500/ul do not have a greater rate of squamous intraepithelial lesions than women without HIV infection suggests that the former can be followed less frequently if they have normal Pap tests. This article summarizes a presentation on HIV infection in women made by Carmen D. Zorrilla, MD, at the 9th Annual Ryan White CARE Act Clinical Update in Washington, DC, in August 2006. The original presentation is available as a Webcast at www.iasusa.org.