Successful management of prenatal hydrops fetalis in a mother with HIV.

The incidence of human immunodeficiency virus (HIV) in pregnancy worldwide is increasing. We have more invasive diagnostic and therapeutic abilities in feto-maternal medicine, creating a dilemma in our management of these pregnancies. Do we aggressively manage them with the risks of vertical transmission or do we try to avoid invasive interventions? In this case, the fetus of a 36-year-old immigrant with HIV is diagnosed with hydrops fetalis. The patient's viral load was 5800 copies/mL, therefore, early intervention was unwise. Optimal HIV management, combined with referral to a specialist feto-maternal medicine unit, regular ultrasound scans and insertion of a pleuroamniotic shunt when the viral load was low, resulted in the delivery of an HIV-negative baby with excellent outcome for both mother and baby.

Gynaecomastia, hyperprolactinaemia and HIV infection.

Endocrine complications of human immunodeficiency virus (HIV) and its treatment are being increasingly recognized. We discuss the diagnosis and management of an HIV seropositive man who presented with bilateral gynaecomastia and 'hyperprolactinaemia' due to macroprolactin within six months of starting antiretroviral therapy. We suggest that the gynaecomastia may be a feature of immune reconstitution disease. Measurement of serum prolactin in the investigation of gynaecomastia should be reserved for those with hypogonadotrophic hypogonadism. Since macroprolactin contributes to circulating prolactin in HIV-seropositive subjects, hyperprolactinaemic samples in these patients should be tested for macroprolactin.