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HIV DISEASE IN PREGNANCY PREFACE HOWARD L. MINKOFF, MD Guest Editor As will be detailed by several contributors to this issue of the Obstetrics and Gynecology Clinics of North America (Melnick, Fowler, and Mathieson), the prevalence of HIV has reached an apparent plateau in some parts of this country, and in many ways the epidemic remains in a very dynamic state. A snapshot of the epidemic taken in 1997 would look dramatically different from one taken just a few years ago. The race and gender of the population infected and affected by HIV has become increasingly minority, increasingly female, and increasingly of reproductive age. These demographic realities, along with the advent of more powerful therapeutic agents, which portend longer, healthier lives for infected women (Cohen), suggest that pregnancies among HIV-infected women will continue to occur and continue to require the compassion and expertise of obstetricians in the United States. This issue presents an extensive review of all aspects of HIV infection in pregnancy, beginning with the counseling and testing of those at risk (Rips) and continuing through the ongoing care of the HIV-infected mother (Korn and Abercrombie) and child after delivery (Melvin and Frenkel). Included within this review are theoretic underpinnings and practical applications, with an emphasis on the latter, as all authors are acutely aware of the clinical background and interests of the Clinics’ readership. The practicing clinician can find within these pages all that is needed to provide optimal care to the HIV-infected parturient. This editor’s summary is designed to serve as a synopsis; guiding the clinician/reader through the tasks required to optimize the outcomes of these often complex pregnancies by highlighting relevant articles and occasionally supplying addenda to the articles authored by the distinguished contributors to this work. THE VIRUS Although HIV was identified more than 10 years ago, the pace of discovery regarding the virology and immunology of the disease has increased dramati- cally of late. Many of the breakthroughs in our understanding of the basic xi

PREFACE

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Page 1: PREFACE

HIV DISEASE IN PREGNANCY

PREFACE

HOWARD L. MINKOFF, MD Guest Editor

As will be detailed by several contributors to this issue of the Obstetrics and Gynecology Clinics of North America (Melnick, Fowler, and Mathieson), the prevalence of HIV has reached an apparent plateau in some parts of this country, and in many ways the epidemic remains in a very dynamic state. A snapshot of the epidemic taken in 1997 would look dramatically different from one taken just a few years ago. The race and gender of the population infected and affected by HIV has become increasingly minority, increasingly female, and increasingly of reproductive age. These demographic realities, along with the advent of more powerful therapeutic agents, which portend longer, healthier lives for infected women (Cohen), suggest that pregnancies among HIV-infected women will continue to occur and continue to require the compassion and expertise of obstetricians in the United States.

This issue presents an extensive review of all aspects of HIV infection in pregnancy, beginning with the counseling and testing of those at risk (Rips) and continuing through the ongoing care of the HIV-infected mother (Korn and Abercrombie) and child after delivery (Melvin and Frenkel). Included within this review are theoretic underpinnings and practical applications, with an emphasis on the latter, as all authors are acutely aware of the clinical background and interests of the Clinics’ readership. The practicing clinician can find within these pages all that is needed to provide optimal care to the HIV-infected parturient. This editor’s summary is designed to serve as a synopsis; guiding the clinician/reader through the tasks required to optimize the outcomes of these often complex pregnancies by highlighting relevant articles and occasionally supplying addenda to the articles authored by the distinguished contributors to this work.

THE VIRUS

Although HIV was identified more than 10 years ago, the pace of discovery regarding the virology and immunology of the disease has increased dramati- cally of late. Many of the breakthroughs in our understanding of the basic

xi