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HIV Disease in Women.
Alexandra Levine.
www.medscape.com, August 24, 1999.
ABSTRACT
Women now constitute approximately 40% of all AIDS cases worldwide, and approximately 20% of cases in the United States. Women represent the fastest rising new group of HIV/AIDS in the United States, rising from 7% of AIDS patients in 1995, to 22% in 1997. The majority of HIV-infected women have now become infected by heterosexual contact. Risk factors for such heterosexual transmission include presence of another sexually-transmitted disease; lack of circumcision in the male partner; cervical ectopy; intercourse during menses; high viral load in the HIV-positive partner. Early signs and symptoms of HIV disease in women include recurrent vaginal candidiasis, likely to be identified when the CD4+ cells are relatively intact. The only major difference in specific AIDS diagnoses between men and women is Kaposi's sarcoma, seen most commonly in men who have sex with men, and least commonly in HIV-infected women. The HIV-infected woman who becomes pregnant may have an increased risk of early fetal loss, but is not expected to experience significant deterioration in HIV disease, as a consequence of the pregnancy. Likewise, major fetal malformations or abnormalities are not expected in the infants born to HIV-infected women, with the exception of fetuses lost within the first ten weeks, and infected prior to that time by HIV. An important issue in HIV-infected women concerns the potential for development of "pre-cancer" (CIN or SIL). Invasive cervical cancer, and its precursor lesions, CIN II or III/ high grade SIL, are associated with prior infection by Human Papilloma Viruses, most commonly types 16, 18, 31, 33, and/or 35. As many as 60% of HIV-infected women are co-infected with some type of HPV, while 24% may be infected by three or more types. Specific infection by HPV 16 or 18 has been reported in as many as 50% of women with CD4+ counts less than 200 cells/mm3. Therapy for precursor lesions has been the same as that employed for HIV seronegative women with CIN. However, local recurrence is quite common in the setting of HIV, occurring in approximately 50% of cases during the first year of follow-up. Actual invasive cervical cancer has been reported in relatively few HIV-infected women. When diagnosed, the disease is likely to present in high stage, with high grade pathologic features, almost uniform relapse after definitive therapy, and short survival. Careful attention to routine HPV and Pap screen testing is mandatory in the management of HIV-infected women.
