As perinatally HIV-infected (PHIV) women reach reproductive age, there is an increasing number who become pregnant. This is a retrospective cohort study of HIV-infected women who delivered from June 2007 to July 2012 at our institution. Maternal demographics, HIV characteristics, and obstetric and neonatal outcomes were compared. 20 PHIV and 80 SHIV pregnancies were reviewed. The groups had similar CD4+ counts, prevalence of AIDS, and use of antiretrovirals (ARV) at initiation of obstetrical care. PHIV women were significantly more likely to be younger, have a detectable viral load (35% versus 74%, ), and have HIV-genotype resistance (40% versus 12%, ) than the SHIV women. The median gestational age at delivery (38 weeks) and rates of obstetrical and neonatal complications were similar between the groups. While the overall rate of cesarean delivery (CD) was similar, the rates for CD due to HIV were higher in the PHIV group (64% versus 22%, ). There was one case (5.3%) of mother-to-child transmission in the PHIV group versus two cases (2.6%) in the SHIV group. In our population, PHIV pregnant women have a higher rate of HIV-genotype resistance and higher rate of detectable viral load leading to a higher rate of CD secondary to HIV. 1. Introduction The first cases of mother-to-infant or vertical transmission of human immunodeficiency virus (HIV) were described more than two decades ago. In the early 1980s, the majority of perinatally acquired HIV (PHIV) children did not survive beyond childhood. As the perinatally infected cohorts have benefitted from combined highly active antiretroviral therapy (HAART), they are living longer and the first wave is reaching adolescence and young adulthood. The estimated number of perinatally infected persons living with HIV was 6,051 in 2005 for the 33 jurisdictions with HIV being reported in the United States [1]. As perinatally HIV-infected females become sexually active, they are in turn at risk of transmitting HIV to their children. Currently health care providers of PHIV women are encountering reproductive health concerns in this population with little evidence to guide them. Although HAART has markedly decreased the risk of perinatal HIV transmission in the USA among adult females infected with HIV and there is substantial literature regarding pregnancy outcomes in HIV-infected women, little is known about the course of pregnancy among perinatally infected females. In an editorial response to a report describing pregnancy in perinatally HIV-infected adolescents and young adults, the Centers for Disease Control
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