Prospective study of human immunodeficiency virus infection and pregnancy outcomes in intravenous drug users.

To determine the effects of human immunodeficiency virus (HIV) infection on pregnancy outcomes, we prospectively studied female intravenous drug users in a methadone program in New York City. Of 191 women with HIV status known prior to pregnancy, 17 (24%) of 70 seropositives and 26 (22%) of 121 seronegatives became pregnant during 28 months of follow-up. Including 54 additional women first tested for HIV antibody after becoming pregnant, 125 pregnancies were studied in 97 women (39 seropositive, 58 seronegative). None of the seropositive pregnant women had advanced HIV-related disease at entry, and only one developed symptomatic disease (oral candidiasis) during pregnancy. No differences were observed between groups in the frequency of spontaneous or elective abortion, ectopic pregnancy, preterm delivery, stillbirth, or low-birth-weight births. Among women giving birth to live infants, seropositives were more likely than seronegatives to be hospitalized for bacterial pneumonia during pregnancy and had an increased tendency for breech presentation, although these events were infrequent. There were otherwise no differences between groups in the occurrence of antenatal, intrapartum, or neonatal complications. Results suggest that asymptomatic HIV infection is not associated with a decreased pregnancy rate or an increased risk of adverse pregnancy outcomes in intravenous drug users, and that an acceleration in HIV-disease status during pregnancy is uncommon.

Methylprednisolone treatment of immunologic infertility in male.

Over a 5-year period, 98 men (101 "cases") with immunologic infertility, as diagnosed by Kibrick and F-D sperm agglutination testing, were treated with one or more regimens of methylprednisolone (96 mg/day for 7 days). Among the 71 patients for whom complete follow-up data were obtained, 31 (44%) succeeded in achieving pregnancy in their partners within 12 months of the start of treatment. The pregnancy-achievers and nonachievers were compared with respect to their semen quality, Kibrick titers, and F-D agglutination before and after therapy. No single, clear-cut factor could be identified to explain, or predict, a successful outcome. However, some men did have improved semen quality; of these, 69% achieved a pregnancy in the partner. Furthermore, pregnancy was somewhat more likely to occur if the man had a decrease in Kibrick titer; a decrease in titer was more likely in men whose titers were higher initially. No correlation with F-D agglutination activity was found. side effects were of limited incidence; only 16% of the men had any discomfort at all, and only 2% of them had severe problems. However, all discomfort and problems were transient.