The immunology of HIV disease and pregnancy and possible interactions

HIV infection may impair a large portion of the human immune response. Infection of CD4⁺ T cells results in depletion of this population, leading to dysfunction of T-cell-dependent activities. Numerous other immune functions are directly or indirectly impaired, including the function of CD8⁺ T cells and decreases in total lymphocytes, IL-2 secretion, IL-2R expression, proliferative response to mitogens, NK activity, ADCC, and several other measures. Immune alterations seen in normal pregnancy include decreases in CD4 and T cells, the proliferative response to mitogen, IL-2 secretion, and NK activity. These changes are largely cellular and usually are not apparent clinically. Normal pregnant women are immunocompetent. When pregnancy is complicated by asymptomatic HIV infection, the obstetric outcome does not seem to be adversely affected. Preliminary studies show that the course of HIV disease may not be adversely affected in these women, but this matter is the subject of intense investigation.