.. tributed to gender differences or to delay diagnosis of women, inferior access to health care and poor utilization of service (12). Utilization of the prescribed drug therapies may affect the course of HIV/AIDS in women. Evidence suggests that a number of HIV-infected women are reluctant to take antiretroviral drugs because of concerns about their effectiveness and side effects, as well as beliefs that drugs are experimental (6). Many women have negative views of available drug therapies because of the lack of relationship between them and their health care providers (6). Consequently, women decide against taking the drugs to help their HIV infection. These clinical manifestations underscore the immediate need for more aggressive study of HIV infection in women. With more extensive research and clinical care, women living with the infection may be able to avoid further AIDS-related illnesses and women without the disease may be able to reduce their risk of infection.
Gynecologic Manifestations: Until recently, AIDS diagnoses have excluded the serious gynecologic manifestations of HIV that have been identified in women for some time (7). Most of the illnesses associated with HIV are found in uninfected women, but occur less frequently, or severity (10). Although the CDC has only recognized cervical cancer in the case definition of AIDS, providers must be alert to the other female-specific conditions that their patients might encounter (12). Candidasis: Vaginal Candidasis has been described as one of the earliest manifestations of immunosuppression in women (12). Refactory Candidasis may be an early warning of HIV infection (7,12). In an early study, 24% of women had chronic refactory Vaginal Candidasis as a complaint (7).
As the illness progresses, the vaginal infection may move to esophageal and tracheal involvement, and ultimately to the stomach in some very severe cases (12). Candida infection of the esophagus has been reported as the most frequent AIDS-defining symptoms in early studies of HIV-positive women (12). It is so common because of the frequent use of antibiotic (13). However, this illness usually responds well to the conventional treatment in women with early HIV infection, but advanced therapy may be called for in a more severe case (13). Herpes Simplex Virus Infection (HSV or genital herpes): Genital herpes simplex infection is dominant in women infected with the HIV virus (7,12).
The genital lesions associated with HSV may be an opportunity for the entry of the virus (12). Thus, lesions that last longer than one month should be looked at and tested for HIV infection (7). HSV is sometimes unresponsive to therapy (10) and can be an AIDS-defining condition and require long-term suppressive therapy (7). Pelvic Inflammatory Disease (PID): Several studies have found a high rate of HIV infection among women with pelvic inflammatory disease (13). Whether HIV is a cofactor or simply a sign for increased risk of infection has yet to be established. One study showed that HIV infected women with pelvic inflammatory disease are less likely to have a white-cell count great than 10,000 (13), which puts a patient at much higher risk for infection. Recommended treatment, is to be hospitalization and treatment with intravenous antibiotics (7,12,13).
Further study is needed in many aspects of gynecologic disease in women with HIV. If the epidemic of the female infections is to be reduced, health care providers must receive education about these life-threatening diseases. PREGNANCY AND HIV: Because most HIV infected women are of childbearing age, considerable research has been conducted on pregnancy-related issues. There is a 25% to 35% risk of perinatal transmission (13), with an estimated 50 to 80 percent of infections occurring late in pregnancy or during birth (10). HIV may be transmitted when maternal blood enters the fetal circulation, or by mucus exposure to the virus during labor and delivery (10). Risks of perinatal transmission are increased if the mother has an advanced case of the HIV disease, large amounts of HIV in her blood stream, or few immune system cells, CD4+ T cells, which are the main targets of HIV (10).
Other factors that may increase the risk of transmission are maternal drug use, severe inflammation of fetal membranes, or a prolonged period between membrane rupture and delivery (10,13,14). In one study, HIV infected women who gave birth more than four hours after their fetal membranes were ruptured were twice as likely to transmit the HIV virus to the infant as compared to women who gave birth within that four hour period (10). In the same study, HIV infected women who used heroin or crack/cocaine during pregnancy were also twice as likely to transmit HIV to their babies than were women infected with the virus who were not injecting drugs. Another risk of transmission is from a nursing mother to her infant (5,10,14). A recent analysis suggested that breast-feeding introduces an additional risk of HIV transmission of about 14% (10).
In one case, an uninfected women who received a Cesarean section needed a blood transfusion due to the massive amounts of lost blood. The baby boy was breast fed, and it was later found that the blood that was given to the women was contaminated with HIV. The mother and baby were both tested and both found to carry the antibodies of HIV. The mother was apparently infected with the disease after delivery. Hence, the baby could have only been infected through breast feeding (5).
For this reason, women who are infected with HIV are recommended to stay way from breast-feeding, despite the slight chance of infection (5,10,14). To prevent transmission of HIV to infants, Zidovudine (AZT) (10,13,15) and prophylaxis are recommended for pregnant women (13). There is limited knowledge with AZT. However, it is known that it crosses the placenta and can be detected in fetal tissue and amniotic fluids (13). When AZT is given shortly before therapeutic abortion of delivery, serum amounts in the newborn are similar to those in the mother; thus reducing the risk of maternal-infant transmission by two thirds (10). AZT is still being studied and perfected.
With further advances, AZT may be able to reduce the risk of transmission to an undetectable amount, giving HIV infected women a less stressful decision when deciding whether or not to continue with their pregnancy. CONCLUSION: More women are becoming infected with HIV. With earlier testing and treatment, women can live with HIV as long as men can. However, in a male-dominated medical establishment, womens health issues are often ignored (16). Some women go straight to their deaths, while others are diagnosed after it is too late (16).
Women need to know more about how they can be infected, and should get tested for HIV if they think that there is any chance that they have been exposed to the virus. This is especially true for pregnant women. Not only are they endangering their own lives, they may be putting an unborn child at risk for a disease that might have been avoidable. If the cycle of female infection is to be broken, health workers must be able to provide appropriate education, counseling and care to women (16). If women are to receive optimal AIDS health care, research must be done specifically to target women (16).
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