The majority of the 17 million women globally that are estimated to be infected with HIV live in Sub-Saharan Africa. summarizes what is known about HIV disease progression in pregnancy specific causes of HIV-related maternal deaths and the potential impact of treatment with antiretroviral therapy on maternal mortality. Recommendations are proposed for improving maternal health and Arry-520 decreasing maternal mortality among HIV-infected women based on existing evidence. pneumonia tuberculosis and respiratory failure of unknown etiology; yet specific pathogens are rarely reported in the literature limiting development and implementation of cause-specific interventions [8]. 5 Direct UTY obstetric complications and HIV-related maternal mortality While the majority of HIV-related maternal deaths are from indirect causes there is evidence that women infected with HIV have an increased risk of death from some obstetric complications. Findings from several studies suggest an increased risk of development of and mortality from both puerperal sepsis especially after cesarean delivery and abortion-related sepsis. HIV infection was shown to be a major risk factor for mortality due to puerperal sepsis and abortion-related sepsis in the 2005-2007 South African confidential enquiries report [8] and HIV-infected pregnant women have approximately six times the risk of developing puerperal sepsis and three times the risk of death from sepsis after delivery [8 24 While data on the topic are limited this risk is also seen in high-income countries despite wide access to and treatment with ART [27]. 6 Effect of antiretroviral treatment on maternal mortality While there has been an increase in the number of pregnant HIV-infected women Arry-520 who have access to and use ART in the past five years there is a jarring lack of published data demonstrating the effect of ART on maternal mortality. In studies that do address the effects of ART on maternal survival conclusions have been inconsistent. In an observational study that reviewed records of HIV-infected women receiving prenatal care in Malawi and Mozambique ART for prevention of mother-to-child transmission reduced the maternal mortality ratio (MMR) 13-fold overall. Furthermore the MMR showed a dose- response effect with the lowest MMR among those women who received ART for Arry-520 more than 90 days [28]. However the study did not compare the MMR for HIV-infected women with those who were uninfected; therefore it is not known if the risk was reduced to the general population level. In a recent systematic review addressing the contribution Arry-520 of HIV to pregnancy related death no difference in the pooled relative risk of mortality was seen in HIV-infected pregnant or postpartum women in studies done during a time when ART was available compared with studies done in an era in which ART was not available [7 12 However as pointed out in that review the studies varied by region and criteria for initiation of ART limiting ART to women with very low CD4 counts. Most pregnant women would either not have had access to ART or received it only at the time of delivery. It is likely that the relative risk of death would be lower in treated pregnant women if all HIV-infected pregnant and postpartum women were on ART [7]. Despite improved access to ART in many countries in Sub-Saharan Africa over the past several years including improved availability to pregnant women most of the available published studies that report maternal deaths comprised women Arry-520 who had little Arry-520 or no exposure to ART or the investigators were unaware of treatment status. While ART will certainly reduce HIV-related maternal deaths the optimal timing of the initiation of treatment and the extent to which treatment will prevent mortality during pregnancy have not been determined. 7 Discussion and recommendations There were an estimated 19 000-56 000 maternal deaths attributed to HIV-related causes in 2011 contributing to some 6%-20% of all maternal deaths worldwide. The contributors to these deaths are multifactorial and include infectious etiologies complications of the pregnancy itself contextual and structural barriers.