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Module 4

Module 4. HIV Infection in Women. HIV Infection in Women. Garrett Colmorgen, MD, Director Maternal Fetal Medicine, Christiana Care Health Services, Wilmington, Delaware

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Module 4

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  1. Module 4 HIV Infection in Women

  2. HIV Infection in Women • Garrett Colmorgen, MD, Director Maternal Fetal Medicine, Christiana Care Health Services, Wilmington, Delaware • Staff of the Pennsylvania/Mid-Atlantic AIDS Education & Training Center, Delaware Local Performance Site - P. Lincoln, N. Bennett, M.A. Bartkowski

  3. Demographics of HIV in Women • Fastest growing group in the United States • 4th leading cause of death aged 25 to 44 in the United States • Disproportionately affects African Americans & Hispanics living on the eastern seaboard CDC-2000

  4. Statistics of HIV in Women • Cumulative Statistics as of December 2000 in the United States • 74,997 African American • 28, 151 White • 25,643 Hispanic • 1,133 Other • Total 130, 104 CDC 2000

  5. HIV Transmission Risk Behaviors for Women • Heterosexual - 62% • African American - 63% • White - 18% • Hispanic - 18% • Other - 1% • primary risk behavior for all age groups of women • IVDU - 35% • Other - 3% CDC 2000

  6. Female Condom • “Reality” - only brand currently marketed in the US • Made of polyurethane, sheath closed at one end with flexible rings at both ends Anderson, J. 2001

  7. Microbicides • Strategy enabling women to have control over safer sex/prevention of HIV • Nonoxynol-9 increases risk of HIV infection • Clinical trials of topical microbicides are being conducted Anderson, J. 2001

  8. Gender Bias Transmission • More efficient from man to woman than woman to man • Related to number of infectious particles in body fluid • Related to volume of fluids exchanged • Related to surface area coming in contact with infected body fluid HRSA:BPHC & AETC

  9. Risk Factors for Male to Female HIV Transmission • Anal Intercourse • Lack of male circumcision • Genital ulcers (syphilis, herpes simplex, chancroid) • Sexually Transmitted Diseases • Multiple sexual partners

  10. Special Consideration • Early Adolescent • immaturity of the female genital track increases risk of transmission • Women over 50 years of age • atrophic vaginitis caused by decreased lubrication • older females are generally not perceived to be at risk

  11. Natural History of HIV Disease in Women • Same as in men except for GYN symptoms and disease conditions • 1993 CDC added invasive cervical cancer as an AIDS defining condition • Women are often diagnosed late • Women may have barriers to care HRSA:BPHC & AETC

  12. Challenges in Caring for Women with HIV • Statistically economically poorer than men • More likely to be single parents • lack of child care • lack of support • More likely to be uninsured HRSA:BPHC & AETC

  13. Signs and Symptoms of HIV in Women • Acute Seroconversion - (No distinct gender differences however many of these s&s often go under addressed) • fever • swollen glands Bartlett, J. 1999

  14. Signs and Symptoms of HIV in Women cont’ • Rash - macular or maculopapular, usually nonpururitic. Truncal / facial distribution can involve arms and legs. Often appears several days past onset of fever. • Fatigue • Mono-spot test is negative • Bartlett, J. 1999

  15. HIV-Related Gynecological Conditions • Vaginal candidiasis • Human Papilloma Virus • Genital Ulcers • Pelvic Inflammatory Disease • Cervical Dysplasia/Neoplasia • Menstrual Disturbances HRSA:BPHC & AETC

  16. Diagnostic Studies • Pap smear • two studies the first year of diagnosis • annually if normal • recommended every 6 months if HIV is symptomatic • Colposcopy USPHS/IDSA 2001

  17. Prenatal & Family Planning HIV Screening • DHHS guidelines suggest universal HIV testing with patient notification as a routine component of prenatal care • Pre and post test counseling & informed consent - laws vary by state USPHS/IDSA 2001

  18. Pregnancy • Does not appear to accelerate HIV infection

  19. Perinatal HIV Transmission May Occur • Antepartum • during pregnancy • Intrapartum • during labor • during delivery • Postpartum-through breast feeding HRSA:BPHC & AETC

  20. Reducing Perinatal Transmission • ACTG 076 • women given AZT after first trimester • AZT administered intravenously during labor • newborn receives AZT for 6 weeks • transmission reduced by 67.5% • Combination therapy has reduced the rate even further HRSA:BPHC & AETC

  21. Antepartum/Intrapartum Management Considerations • Avoid amniocentesis • Avoid premature rupture of membranes • Avoid fetal scalp monitoring • Delay episiotomy HRSA:BPHC & AETC

  22. HIV Medications to avoid during Pregnancy • Efavirenz - associated with anencephaly, anopthalmia Neural tube defects in primates • Indinavir - Potential for nephrolithiasis and neonatal hyperbilirubinemia DeLorenzo, L. 2001

  23. HIV Medications to avoid during Pregnancy, cont’ • Didanosine/Stavudine - combination associated with fatal lactic acidosis in pregnancy • Stavudine/Retrovir -combination is antagonistic, decreasing efficacy of therapy DeLorenzo, L. 2001

  24. Antiretroviral Pregnancy Registry • Collaborative effort between the CDC, NIH and pharmaceutical companies to monitor for birth defects in infants exposed to antiretroviral agents • antiretroviral exposure during pregnancy should be reported to the registry at 1-800-258-4263 Anderson, J. 2001

  25. Current Prevention Message-Is it Reality ? • Abstinence • Monogamy • Reduce number of partners • Ask partner about history of infection • Enforce use of condoms Colmorgen, G. 1999

  26. References • Anderson, J. (Ed.) (2001). A guide to the clinical care of women with HIV. Rockville, MD: HIV/AIDS Bureau, Health Resources and Services Administration. [Available on-line: http://www.hab.hrsa.gov/publications.html]. • Bartlett, J. & Gallant, J. (2001). 2001-2002 Medical Management of HIV Infection. [Available on-line: http;//hopkins-aids.edu

  27. References, cont’ • Center for Disease Control and Prevention. (2002,February). Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States. [Available on-line: http://www.hivatis.org.]

  28. References, cont’ • DeLorenzo, L. (2001). Clinical Nursing Series. Nursing Care of the HIV-Infected Patient. Fourth Edition.Western Schools Press.

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