HIV in Pregnancy Health Article

What Do I Have?

The human immunodeficiency virus (HIV) is caused by an RNA retrovirus. The principal viral strain responsible for this disease in the United States is HIV-1. HIV-2, a closely related virus, occurs primarily in West Africa, Portugal, and France. HIV-2 infection is uncommon in the U.S., except in individuals who have traveled to endemic regions of the world and in those who have had sexual contact or shared needles with persons from those countries.

HIV attacks a specific type of cell, the CD4 lymphocyte. Lymphocytes are white blood cells that function as part of the body's immune defenses; the primary function of CD4 cells is to protect the body against infection from fungi, parasites, and viruses (and some bacteria). When the CD4 cells are weakened, the body becomes susceptible to an extensive variety of opportunistic infections (infections that do not cause disease in people with normally functioning immune systems) and cancers. HIV, then, causes AIDS (acquired immunodeficiency syndrome), which is defined as an advanced syndrome of HIV infection where patients are susceptible to a variety of infections.

Prevalence in the United States

Presently, more than half a million Americans have died from AIDS. An additional one million are currently living with HIV/AIDS in the U.S. Most of those patients are infected with HIV, but are not yet in the terminal stage of their illness. Approximately 40,000 of those patients have full-blown AIDS.

In the U.S., approximately 26% of all HIV cases occur in women. Almost 75% of infected women are African-American (68%) or Hispanic. Among pregnant women, some high risk populations have prevalence rates of HIV infection that approach one in 200, but overall rates of HIV infection in pregnant women have been decreasing in the U.S.

How Is HIV Transmitted?

HIV infection is transmitted through contact with body fluids-including semen, vaginal secretions, blood, breast milk, or cerebrospinal fluid-that contains particles of the virus or cells infected with the virus. The three primary ways HIV spreads are through:

• sexual relations;
• exposure to contaminated blood (through sharing of needles, transfusions, or accidental pricks from needles); and
• mother-to-child transmission, before birth, during delivery, or through mother's milk.

In women, the two most common mechanisms of acquiring HIV infection are intravenous drug use and heterosexual contact with a high-risk male. In fact, heterosexual transmission is becoming a more common cause of HIV spread, especially in African-American populations. Several sexual practices substantially increase the risk of transmission. Of these, the most common is unprotected vaginal or anal intercourse with multiple partners. Other independent factors, when combined with unprotected sex, increase risk for HIV infection. These include:

• the presence of other sexually transmitted diseases (STDs) that cause genital ulcers, such as herpes, syphilis, and chancroid;
• concurrent use of illicit intravenous drugs or crack cocaine, which can impair judgment;
• sexual contact with a non-circumcised male; and
• anal intercourse

What Are the Consequences of HIV Infection?

HIV infection occurs in a continuum that can be divided into four stages.

Stage One-The Acute Phase

Stage one is the acute infection that develops several weeks after exposure to the virus. In this stage, the patient has symptoms and signs similar to those seen in infectious mononucleosis (malaise, fatigue, fever, poor appetite, lymph node enlargement, sore throat, rash, and enlarged liver and spleen). After several weeks, the acute episode resolves, the symptoms disappear, and the patient enters the latent phase of the illness.

Stage Two-The Latent Phase

During this phase, the patient shows no symptoms, but the virus continues to reproduce itself in lymphatic tissue and in the bloodstream. The latent phase lasts from five to 10 years for most patients. As the body's "load" of the infectious virus progressively increases, the patient enters stage three of the disease.

Stage Three-Worsening of Symptoms

This stage is characterized by mild to moderately severe symptoms (fatigue, weight loss, poor appetite, nausea, vomiting, diarrhea, confusion) and some common infections (such as frequent bacterial pneumonias and skin infections),. (Once symptomatic HIV infection develops, the patient's life expectancy is usually three to five years, without treatment.)

Stage Four-AIDS

Ultimately, the patient will develop the fourth and final stage of the illness, the acquired immunodeficiency syndrome (AIDS). AIDS begins when the infected person's count of CD4 lymphocytes drops below a certain level (<200 cells/mL). A severely disabled immune system makes the person susceptible to numerous opportunistic infections, which are infect