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Special Management Concerns for Women
Any treatments undertaken should be designed with an understanding of and respect for the infected woman’s risks and intentions regarding pregnancy. Infected women who wish to become pregnant should be advised that risk for transmission to their children cannot be eliminated completely by any known therapy. Women who wish to prevent pregnancy should be counseled about family planning options. Concerns for pregnant women with HIVThe majority of cases of MTCT (also called vertical transmission or maternal-fetal transmission and, more recently, parent-to-child transmission) appear to occur during labor and delivery. This may take place, for example, during contact with infected secretions, including blood from the mother’s genital tract during labor and delivery. It is important to know the mother’s HIV status during pregnancy in order to begin employing risk-reduction therapies as quickly as possible. These include prophylactic treatment of opportunistic infections and antiretroviral therapy both for the mother during pregnancy and for the child postpartum in settings where these treatments are available. RTIs/STIs in women with HIVGynecological infections in women with HIV infection may be more severe and more difficult to treat than those in uninfected women. In addition, RTIs and STIs can greatly enhance the risk of HIV transmission. HIV-infected women often come to reproductive health care providers with relatively common gynecological complaints that are not recognized as possible symptoms of HIV infection, which can result in missed opportunities for testing. For example, women who have chronic or recurring yeast infections could be infected with HIV. Although vaginal yeast infections are very common in women in general, chronic or repeated episodes suggest HIV infection (or another disorder that suppresses the immune system). HIV-infected women may have severe yeast infections that do not respond well to treatment. In some women, it may be necessary to use medicine daily to prevent recurrence. Women with HIV experience other RTIs/STIs and gynecologic problems, most
of which occur in uninfected women as well, but with less frequency and
severity. These include trichomonas infection, bacterial vaginosis, gonorrhea,
chlamydia, genital ulcer disease (e.g., herpes, syphilis, chancroid),
pelvic inflammatory disease, and genital warts. (See EngenderHealth’s
minicourse on Sexually Transmitted Infections
for more information on these infections.) Menstrual abnormalities,
such as spotting and irregular menstrual cycles, are also common in women
with HIV infection.
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A number of treatment and management concerns are specific to women infected
with HIV. Whether pregnant or not, HIV-infected women should receive counseling
about contraceptive use, risks of MTCT, and the possibility of harmful
effects of drugs, including some antiretroviral drugs, during pregnancy.
