Primary care of women infected with the human immunodeficiency virus

Abstract

AIDS is the leading cause of death among women aged 25 to 34 years in New York City. Gynecologic care should be directed toward early identification and aggressive treatment of infectious and neoplastic processes that may take a more fulminant course in immunosuppressed women. Dealing with women's contraceptive needs highlights the problem of preventing sexually transmitted diseases through contraceptive technology. Public health policies and recommendations will be of no avail without an educated and supportive medical community.

PIP: Both acquired immunodeficiency syndrome (AIDS) surveillance data and surveys on the seroprevalence of human immunodeficiency virus (HIV) indicate that HIV infection through heterosexual transmission is showing a trend of dramatic increase among US women. In women, especially pregnant women, AIDS has a more fulminant course than in men and there is a shorter survival time from diagnosis to death. Gynecologists may be the first source of medical contact among asymptomatic HIV-positive women, and primary care providers should aware of unusual gynecologic manifestations of HIV infection. Protracted herpes infection, refractory vaginal candidiasis, and widespread condylomata often represent early warning signs of an underlying immunocompromised state. Women with impaired cellular immunity are at greater risk of genital papillomavirus and neoplasia. Deficient cellular immunity also facilitates activation of latent infections such as cytomegalovirus, herpes simplex, and papillomavirus. Pelvic inflammatory disease is found in a disproportionately high number of HIV-infected women, although it is unknown whether the inflammation is secondary to the AIDS virus or a co-factor. Genital ulcers both increase the risk of HIV seroconversion and enhance the infectiousness of women already HIV-positive. Herpes simplex and other gynecologic conditions are likely to be more fulminant in presentation, more protracted in course, and resistant to conventional therapy in HIV-infected patients. To facilitate the early identification and treatment of these conditions, Pap smears should be taken every 4-6 months in infected women and there should be liberal use of colposcopy. Oral contraceptive users should be advised to switch to condom/nonoxynol-9 use to reduce the potential for disease transmission and accelerated progression.