TreatmentUpdate 73 - Volume 8, No 9; November 1996
Sean Hosein

"Early reports suggested that women with HIV infection were at greater risk of death than men [with HIV infection]." This was probably caused by several factors, including:

* delays in the diagnosis of HIV infection

* late treatment for HIV/AIDS

* "poor access to health care, including antiretroviral [drugs] and [other drugs used to prevent the life-threatening infections seen in AIDS]."

* poverty

* "less social support compared with men"

Infections/complications, who gets what?

* Yeast and herpes

In the time before the widespread use of preventive doses of antibiotics in PHAs, the most common life-threatening infection was PCP. In women with HIV infection, yeast infections in the mouth/throat and sores/ulcers caused by herpes viruses are more common than in men.

* Cervical cancer

Between 31 and 47% of HIV-infected women have abnormal Pap smears. As their immune system weakens the risk of cancer rises. The Centers for Disease Control in the US has issued guidelines for the use of Pap smears:

* Pap smears should be done when an HIV-positive woman is first evaluated by a doctor

* if this Pap smear is normal, another should be done in 6 months

* if the 2nd Pap smear is normal, repeat once each year [Note: some doctors and HIV-infected women choose to have the smears repeated every six months]

* if the Pap smear shows signs of infection, repeat within 3 months

* if the Pap smear finds abnormal cells, then a biopsy should be performed

* STDs

In one study of nearly 400 HIV-infected women, doctors found vaginitis (inflammation of the vagina) and,

* 40% had bacterial infections

* 10% had yeast infections

HIV infection does not appear to make gonorrhea and chlamydia more severe, but the virus may make syphilis more 'aggressive' in some people. Women with HIV infection may also have more severe herpes infections of the genitals than non-HIV-infected women. The chronic infection of the reproductive organs of women, PID (pelvic inflammatory disease), is more severe in HIV-infected women than non-HIV-infected women. Guidelines for the treatment of PID appear in TreatmentUpdate 52.

REFERENCES:

1. Cu-Uvin S, Flanigan TP, Rich JD, et al. Human Immunodeficiency Virus type 1 infection and Acquired Immunodeficiency Syndrome in North American women. American Journal of Medicine 1996;101:316-322.

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