HIV in pregnancy

Acute HIV infection, also called the acute retroviral syndrome, is the symptomatic viremic phase in the days to weeks after HIV acquisition, presenting with fever, fatigue, myalgia, rash, and pharyngitis at a time when antibody testing may still be negative. Diagnosis requires an HIV RNA viral load, and antiretroviral therapy should begin as soon as the patient is ready, regardless of CD4 count.

HIV-associated nephropathy is the collapsing variant of focal segmental glomerulosclerosis seen in HIV infection, driven largely by the high-risk APOL1 genotype, and confirmed by kidney biopsy. Antiretroviral therapy started immediately, plus a tenofovir alafenamide-based regimen and RAS blockade, is the cornerstone of management.

Syphilis is a sexually transmitted infection with the spirochete Treponema pallidum that progresses through painless chancre (primary), disseminated rash and condyloma lata (secondary), latent, and tertiary stages including neurosyphilis, diagnosed by paired nontreponemal and treponemal serology and treated with a single dose of intramuscular benzathine penicillin G for early disease.

Toxoplasmosis is infection with the protozoan Toxoplasma gondii, acquired from undercooked meat or cat feces, causing a mononucleosis-like illness in immunocompetent hosts, reactivation encephalitis with ring-enhancing brain lesions in advanced HIV, and a severe congenital syndrome after maternal primary infection in pregnancy. Diagnosis in CNS disease is largely presumptive on serology, imaging, and empiric treatment response, and management is pyrimethamine-sulfadiazine-leucovorin, with prevention centered on CD4-based prophylaxis and food/cat-litter precautions in pregnancy.

Hepatitis B virus is a bloodborne and sexually transmitted DNA virus that causes acute hepatitis and, when infection becomes chronic, progresses through immune-tolerant, immune-active, immune-control, and reactivation phases toward cirrhosis and hepatocellular carcinoma. Diagnosis rests on hepatitis B serology, chronic infection is treated with entecavir or tenofovir, and reactivation during immunosuppression is prevented with prophylactic antiviral therapy.

Gestational diabetes mellitus is carbohydrate intolerance first identified in the second or third trimester, diagnosed with a 50-g glucose challenge test followed by a confirmatory 100-g oral glucose tolerance test. Insulin is first-line pharmacologic therapy when glycemic targets are not met with diet and exercise, and untreated hyperglycemia drives fetal macrosomia, shoulder dystocia, neonatal hypoglycemia, and later maternal type 2 diabetes.

Cytomegalovirus is a ubiquitous herpesvirus that is usually asymptomatic or causes a heterophile-negative mononucleosis-like illness in healthy hosts, but reactivates to cause retinitis, colitis, pneumonitis, or encephalitis in transplant recipients and patients with AIDS; treatment is systemic ganciclovir or valganciclovir, with foscarnet and cidofovir reserved for resistance or intolerance.