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HIV Infection in Women

The fastest-growing group becoming infected with HIV is women in their childbearing years, and nearly all children with the infection acquire it perinatally. Women account for 15% of total AIDS cases and for 20% of new cases. AIDS now represents the third most common cause of death in young women overall and the leading cause of death in young African-American women. In over half of HIV-infected women, the infection was acquired through heterosexual contact. Gynecologic complications of HIV infection include a high incidence of abnormal findings on Pap smear, severe pelvic inflammatory disease, breast cancer, and recurrent or persistent vaginal fungal infection.

Cervical disorders

Human Papilloma Virus and Cervical Neoplasia. Cervical cancer has an increased occurrence and aggressiveness in women with HIV infection. Cervical cancer constitutes an AIDS diagnosis. HPV is an etiologic factor in human and cervical cancer .

Immune suppression increases susceptibility to infection by HPV. HPV prevalence, acquisition, and retention are higher in HIV-positive women. The frequency of abnormal Papanicolaou smear results is increased in HIV-infected women. Squamous intraepithelial lesions have a prevalence of 40%.

Because CIN is more frequent and more aggressive in women with severe immunosuppression, a Pap smear should be obtained every 6 months.

Performing a Pap screening every 6 months along with careful vulvar, vaginal, and anal inspection is recommended, especially with more immunosuppressed patients with T cells less than 200 cells/mm3. Colposcopic evaluation of women should be performed with any atypical squamous cells of unknown significance (ASCUS), atypical glandular cells of unknown significance, low-grade and high-grade SIL on any Pap smear, or any persistent inflammation that is unresolved after treatment for GC, Trichomonas, or Chlamydia.

Vaginal candidiasis

Vaginal candidiasis, a frequent disorder in women in the general population, may be a source of morbidity for HIV-infected women. Severe vaginal candidiasis is a designated HIV-associated symptomatic disorder.

Vaginal candidiasis may occur in early or late HIV disease, but many women with severe immunosuppression do not have Candida vaginitis.

HIV transmission to the infant

Zidovudine (Retrovir) administration during pregnancy, labor, delivery, and (administered to the infant) the newborn period reduces the transmission of HIV to 8%, compared with 25% in untreated patients.

After delivery, breast-feeding increases risk of transmission of HIV from mothers to infants by about 10% to 19%. Therefore, HIV-infected women are advised against breast-feeding.

Considerations for antiretroviral therapy in the HIV-infected pregnant woman

ZDV and 3TC have been evaluated in infected pregnant women, and both appear to be well tolerated and cross the placenta, achieving concentrations in cord blood similar to those observed in maternal blood at delivery.

ZDV has been shown to reduce the risk of perinatal HIV transmission when administered orally after 14 weeks gestation and continued throughout pregnancy, intravenously administered during the intrapartum period.

Monotherapy with ZDV for chemoprophylaxis during pregnancy should be considered for women with CD4 + counts >500/mm3 and plasma HIV RNA less than 10,00020,000 RNA copies/mL.

Monitoring and use of HIV-1 RNA for therapeutic decision-making during pregnancy should be performed as recommended for non-pregnant individuals. Chemoprophylaxis should include intravenous ZDV during delivery.