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Women account for half of the global human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) infections. Heterosexual contact is the leading risk factor in women. Over 50% of patients are significantly immunosuppressed at the time of diagnosis. Women with advanced HIV infection are at a risk for opportunistic infections (OIs). OIs lead to significant morbidity and cost. Some of OIs may impact women more significantly than men, that is, human papillomavirus infection and cervical cancer. OIs during pregnancy can increase the risk of maternal-to-child transmission of HIV and some OIs, such as Hepatitis C. This chapter will review of OIs that are most important in women's health.

Varicella occurring in pregnancy can be dangerous for the fetus, the mother, and the newborn. The fetus may experience multiple system damage. The mother and newborn are at increased risk for varicella pneumonia with a 9% and 20% fatality rate, respectively. The recent introduction of the varicella vaccine will affect the occurrence of gestational infection. Toxoplasmosis is rarely dangerous for the pregnant woman, yet the fetus and newborn may be at risk for chorioretinitis, hydrocephalus, intracranial calcifications, and convulsions. The greatest challenge in the management of toxoplasmosis in pregnancy is diagnosis of the asymptomatic newborn before damage occurs. Strategies to prevent toxoplasmosis should be taught to every pregnant woman as part of parental care.

For hepatitis B, universal screening of pregnant women for HBsAg along with the combined use of hepatitis B vaccine and HBIG in infants of infected mothers appears to be the best way to detect and prevent vertically transmitted infection. Cytomegalovirus is the most common congenital viral infection, but the lack of a good screening test precludes its accurate and rapid diagnosis. For HPV-B19, larger and more controlled studies are needed to confirm the safety and effectiveness of fetal blood transfusions in the management of hydrops fetalis caused by this infection. Finally, the fact that most mothers of HSV- and toxoplasma-infected neonates have no history of infection, and are asymptomatic at the time of delivery, underscores the need for a high index of clinical suspicion in sick neonates.

In 73 consecutive kidney transplant recipients, anti-Toxoplasma antibodies were determined before transplantation and during a 3-year follow-up after transplantation. In 9 patients, antibody titers increased significantly after transplantation. Antibody titers to various viral antigens determined in parallel remained unchanged, suggesting that the anti-Toxoplasma antibody increase was not due to polyclonal nonspecific stimulation. In 2 of the 24 pretransplant seronegative patients, acquired toxoplasmosis was diagnosed serologically after transplantation, with the observation of a strong IgM and IgG antibody response. The incidence of toxoplasmosis in this group of patients was not found to be significantly different from that in a normal population, suggesting that transmission of Toxoplasma from the transplanted kidney may not be a significant mode of contamination. Among the 49 patients who were seropositive before transplantation, reactivation of toxoplasmosis was suspected in 7 cases on the basis of a significant increase in IgG antibodies. Reactivation occurred more frequently in patients treated with azathioprine and antithymocyte globulin, and a direct relationship between administration of steroids and antibody increase was demonstrated in three patients. Although toxoplasmosis has occasionally been reported as a major infectious problem in kidney transplant recipients, our clinical and serological data show that the potential risk of developing Toxoplasma infection is low since none of the patients with either acquired or reactivated toxoplasmosis developed clinical disease.

A pregnant woman contracted toxoplasmosis from exposure to oocysts shed by cats. She underwent amniocentesis for a therapeutic abortion, and Toxoplasma gondii was isolated from the amniotic fluid and placenta. This method may be useful in determining whether the fetus is infected in cases of toxoplasmosis acquired during pregnancy.