Reproductive-age women constitute an increasing percentage of individuals infected with human immunodeficiency virus. As clinical management issues particular to pregnancy become increasingly common, they are also becoming increasingly complex. With the approval of new antiretroviral agents, monotherapy with zidovudine, although still standard for prevention of mother-to-child transmission of human immunodeficiency virus, has become inadequate therapy for treatment of the mother. Clinicians must now consider alternative therapeutic strategies in spite of a dearth of experience in the setting of pregnancy. To facilitate optimal drug treatment of human immunodeficiency virus-infected pregnant women while maintaining a focus on prevention of transmission, we reviewed Medline, Reprotox, personal files, and pharmaceutical industry information about the antiretroviral agents currently approved. After summarizing potential beneficial and detrimental effects in both the pregnant and nonpregnant individual, we suggest clinical strategies and discuss the ethical and legal principles that should guide therapeutic decisions in pregnancy.
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As life expectancy among patients infected with the human immunodeficiency virus (HIV) increases, a growing number of complications have been observed. This population displays an elevated risk of ischemic necrosis of the femoral head in comparison to the general population, which may be attributed to HIV infection, antiretroviral medication use, and hormone application. Patients infected with the human immunodeficiency virus (HIV) who also have necrosis of the femoral head tend to present at an earlier age, with a rapid disease progression and a high incidence of bilateral onset.
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From the Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA (EPB, JIT); Department of Public Health Sciences, Clemson University, Clemson, SC (MH, SSL); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (LBS); Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (SM); Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA (PL); Department of Pharmacy Practice and Clinical Research, University of Rhode Island, Kingston, RI (LET); West Virginia University School of Medicine, Morgantown, WV (JF); Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (AK); Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY (BN); Department of Psychology, Clemson University, Clemson, SC (IP-V); University of New Mexico Health Sciences Center, Department of Internal Medicine, University of New Mexico, Albuquerque, NM (KP); and Department of Medicine, University of South Carolina School of Medicine, Greenville, SC (AHL).
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Advances and applications of genome-edited animal models for severe combined immunodeficiency.
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Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong 510280, China. E-mail:
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