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HIV is a retrovirus that infects T helper lymphocytes, cells that co-ordinate the actions of other immune system cells and carry the CD4 receptor. Without treatment, over time the patient's CD4 count declines, susceptibility to infections increases, symptoms develop, and become more severe until a diagnosis of AIDS (acquired immune deficiency syndrome) is made.
HIV is associated with significant mortality, serious morbidity and high costs of treatment and care. Around 100,000 people are living with HIV infection (diagnosed and undiagnosed) in the UK. The infection is still frequently regarded as stigmatising, and has a prolonged 'silent' period during which it often remains undiagnosed.
Anti-retroviral therapy (ART) has resulted in substantial reductions in the number of people who progress to AIDS and deaths in the UK. People diagnosed promptly with HIV and started on ART early can expect near normal life expectancy. The number of circulating viruses (viral load) predicts progression to late-stage HIV disease.
HIV in pregnancy
All pregnant women are recommended screening for HIV infection (as well as syphilis, hepatitis B and rubella) in every pregnancy at their booking antenatal visit. In 2013, 2.5 pregnant women per 1,000 were HIV-positive and the majority had been diagnosed before pregnancy. Without intervention, between 15-45 per cent of babies born to HIV-infected mothers in the most severely affected parts of the world are also infected, but with appropriate interventions, mother-to-child (vertical) transmission rates can be reduced to less than 1 per cent.
Interventions include ART, elective caesarean section (unless viral load is very low [less than 50 copies/ml]) and avoidance of breast-feeding after delivery.
The Practising Midwife featured article
HIV and Pregnancy: Challenges in Practice
2011; 14(3); 15-18
Author: Sharon Wilson
Public Health England. (2014) HIV surveillance, data and management https://www.gov.uk/government/collections/hiv-surveillance-data-and-management
Knott L. (2016) Human immunodeficiency virus (Professional reference). http://www.patient.co.uk/doctor/human-immunodeficiency-virus-hiv
Knott L. (2015) Management of HIV in pregnancy (Professional reference).