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).
|
