As reproductive-aged cisgender women continue to be diagnosed with human immunodeficiency virus (HIV) in larger numbers, the topic of women and HIV is becoming a focus for many OB/GYNs. Although the U.S. Centers for Disease Control and Prevention (CDC) notes that HIV rates among American women have declined in recent years, an estimated 7,000 U.S. women were diagnosed with the virus in 2018. Globally, the statistics are much higher: Worldwide, more than half of adults living with HIV are women, and nearly half of new infections in 2019 were in women and girls, according to amFAR, the foundation for AIDS research.
Because patients can also develop HIV-related conditions that can affect gynecologic health, it is critical for healthcare providers to ensure optimal, informed care for these patients. Here's what to know about cisgender women and HIV and how to provide treatment for this patient population.
Women and HIV: Screening and Care for Related Conditions
Some HIV-related conditions involve gynecologic health, while others can co-occur with HIV. Common gynecologic conditions include the following.
- Lower genital tract neoplasia: Patients infected with both HIV and human papillomavirus (HPV) are significantly more likely to develop cervical neoplasia, and HIV itself increases the incidence and persistence of HPV infection. Independent of HPV, HIV is associated with a four- to six-fold increased risk for squamous intraepithelial lesions or cervical intraepithelial neoplasia compared with uninfected women, according to the Global Library of Women's Medicine (GLOWM). The CDC has classified invasive cervical cancer as an AIDS-defining malignancy since 1993. Vulvar, vaginal and anal intraepithelial neoplasia are also more prevalent among women with HIV. Careful examination and regular Pap smears are important for this population.
- Sexually transmitted infections (STIs): Women with an existing STI are two- to five-fold more likely to be infected with HIV, and HIV can make symptoms of other STIs worse. Those who also are infected with the herpes simplex virus may experience more frequent and severe episodes of genital lesions compared with their HIV-negative peers. OB/GYNs should stress the importance of barrier methods, such as condoms, and offer patients vaccination against hepatitis B and HPV, both vaccine-preventable STIs (with some age limitations).
- Pelvic inflammatory disease (PID): Because the presence of HIV in women with PID ranges from 6.7 percent up to 22 percent, patients with PID should be offered HIV testing.
- Vaginitis: Vaginal infections such as candidiasis are associated with increased transmission of HIV. Diagnosis and treatment of candidiasis and other vaginal infections are the same in HIV-positive women as in those who are HIV-negative.
- Menstrual disorders: Some studies have found a link between HIV infection and higher rates of amenorrhea and other menstrual irregularities, notes GLOWM. OB/GYNs should be sure to ask HIV-positive patients about their menstrual cycles.
Even as rates of HIV infection appear to be declining in women, the virus remains an important and impactful factor in gynecologic health. By understanding the effect of co-occurring infections and other health concerns, OB/GYNs can help address the topic of women and HIV with their patients.
