Epidemiology of HIV infection and AIDS in childbearing women in the United States.

HIV infection and AIDS is of increasing prevalence among women in the United States, as documented by the AIDS surveillance data and HIV-seroprevalence data from pregnant women and parturients. Monitoring epidemiologic trends in childbearing women has required clever and creative strategies like those of Hoff et al. The impact on women in the reproductive years, on the reproductive health of these women, and on the outcome of their pregnancies is of substantial concern. The effect of HIV infection on pregnancy and of pregnancy on HIV infection must be clarified but suggests that monitoring T cell levels in pregnancy may be of benefit in identifying women at risk of serious infections. Treatment of HIV-infected women with antiretroviral and other therapies may happen in the future not only to treat the mother but also to investigate the prevention of in utero transmission. In the meantime, studies of the natural history of HIV infection in HIV-infected pregnant women are necessary to clarify when, by what mechanism, and how to prevent in utero transmission of infection from mother to fetus. The committee on AIDS Research and the Behavioral, Social and Statistical Sciences of the National Research Council is optimistic that "the statistics derived from the survey of childbearing women in the United States will provide a basis both for projecting future AIDS cases among infants and, perhaps most importantly, for monitoring the prevalence of infection among an important part of the population of heterosexually active women." The epidemic of HIV in men, women, and children will be controlled not only by finding effective treatments but also by developing strategies that prevent the spread of infection from one person to another. As Quinn et al. stated in a recent editorial, "The rate of increase will be influenced markedly by our degree of success in preventing the sexual, parenteral and perinatal transmission of HIV.... Without immediate action, the spread of HIV and related retroviruses is likely to escalate throughout our hemisphere and to have a profound impact on the medical, cultural, economic and political structure of the Americas."