Hence, without this diagnosis, many women are unable to receive health benefits and services available to those with an “official” AIDS diagnosis (12).
Further data that show that women with AIDS do not survive as long after diagnosis as men and, once diagnosed, become sick faster and die sooner than men with AIDS (12).
Some studies suggest this be attributed 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)..