Obstetric and newborn infant outcomes in human immunodeficiency virus-infected women who receive highly active antiretroviral therapy.

OBJECTIVE: Our aim was to examine perinatal outcomes in women who are infected with human immunodeficiency virus (HIV) and who receive highly active antiretroviral therapy compared with the general population. STUDY DESIGN: In this retrospective cohort study, we compared 151 HIV-positive and 302 HIV-negative women. We defined highly active antiretroviral therapy as concomitant use of at least 3 antiretroviral drugs. We calculated frequencies and odds ratios for adverse pregnancy outcomes. RESULTS: Compared with control subjects, smoking (odds ratio, 4.62; 95% confidence interval [CI], 2.58-8.27), drug abuse (odds ratio, 5.48; 95% CI, 2.21-13.59), and spontaneous preterm birth (adjusted odds ratio, 2.27; 95% CI, 1.22-4.25) were more common among HIV-positive women. HIV-positive women were more likely to deliver a small-for-gestational-age infant, but this was due to higher tobacco and cocaine use. Neonatal outcomes were otherwise similar. CONCLUSION: HIV-positive women are at increased risk for preterm birth and lower birthweight infants; therefore, antenatal surveillance should include fetal growth assessment. Highly active antiretroviral therapy use does not increase maternal complications.

Unrecognized HIV infection among patients attending sexually transmitted disease clinics.

OBJECTIVES: This study examined voluntary HIV testing rates in sexually transmitted disease (STD) clinics. METHODS: Anonymous, unlinked surveys of HIV seroprevalence and medical chart abstractions were conducted in 28 STD clinics in 14 US cities in 1997. RESULTS: Among the 52 260 patients included in the anonymous HIV serosurveys, voluntary HIV testing rates by clinic ranged from 30% to 99% (median = 58%). Patients not tested were more likely to be HIV infected than were patients who were tested, even after those with documented HIV infection were excluded, regardless of demographic characteristics, risk group, or STD diagnosis. CONCLUSIONS: HIV infection is unrecognized in substantial numbers of patients with HIV infection visiting STD clinics. Efforts are needed to increase HIV testing and counseling of all patients visiting these clinics.

HIV seroincidence among patients at clinics for sexually transmitted diseases in nine cities in the United States.

Although the numbers of newly reported diagnoses of AIDS decreased in the 1990s, it is not clear whether they reflect a decreasing number of new HIV infections. Direct measurement of HIV incidence through follow-up cohort studies is difficult and costly. We estimated HIV incidence and trends in incidence among men who have sex with men (MSM) and heterosexual men and women at clinics for sexually transmitted diseases (STDs) by using a recently developed serologic testing algorithm that requires only a single blood specimen. Cross-sectional anonymous serosurveys were conducted at 13 STD clinics in nine cities in the United States from 1991 through 1997. Before anonymous HIV testing, demographic and clinical information was abstracted. Of 129,774 specimens tested, 362 (0.28%) were from persons estimated to be recently infected. Incidence among MSM was 7.1% (95% confidence interval (CI): 4.8-10.3), 14 times higher than that among heterosexuals, which was 0.5% (CI: 0.4- 0.7). Incidence among MSM and heterosexuals remained unchanged during the time studied. Decreasing rates of new AIDS diagnoses in the 1990s do not reflect stable rates of new HIV infections among MSM and heterosexual patients attending these clinics.