The patient with HIV

Since 1998 the risk of transmission of HIV from mother-to-child has dropped considerably in western Europe and North America by the introduction of highly active antiretroviral therapy (HAART) as prophylactic treatment of HIV-infected pregnant women. Not long before this, HAART was successfully introduced to treat HIV-infected persons with a low cellular resistance or AIDS without the high threat of viral resistance. HAART dramatically changed the lifeexpectancy of HIV-infected people and turned HIVinfection from a lethal disease into a chronic disease like insulin dependent diabetes or chronic hepatitis B. Concordant or discordant HIV-infected couples started to consider pregnancy and asked for preconceptional advice. This chapter describes the history and pathogenesis of mother-to-child transmission (MTCT) of HIV, the therapeutic developments and efficacy of prevention of MTCT (PMTCT). It then focuses on the known or suspected drawbacks of these interventions on the health of the mother and child, on risk factors with respect to some serious side-effects and on the measures that can be taken to avoid side-effects as much as possible. Finally, the processing of semen to avoid HIV-infection of the woman in a HIV-discordant couple is briefly discussed.