All pregnant HIV-infected patients beyond 14 weeks gestation should be on zidovudine therapy in an effort to decrease the risk of vertical transmission. Randomized clinical trials of zidovudine have documented a reduction in the vertical transmission rate from 25 to 8 percent. 11 Pregnancy does not appear to alter the natural course of HIV disease, nor do uninfected babies born to HIV-positive women appear to be at increased risk for neonatal complications when compared with appropriate control patients. Patients with CD4+ counts of <200 should be maintained on prophylaxis for Pneumocystis carinii pneumonia using trimethoprim/sulfamethoxazole (TMP/SMX; Bactrim DS). Alternatively, aerosolized pentamidine may also be used in pregnant patients. Treatment of overt opportunistic infections in HIV-infected pregnant women should be addressed just as in those who are not pregnant. Patients may present with respiratory insufficiency. The prompt initiation of artificial ventilation in such patients may improve the intrauterine environment and therefore the outcome for the fetus.
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