Women and HIV/AIDS
September 15, 2015
HIV treatment studies (clinical trials) have traditionally included very small numbers of women. As a result, most information on the effectiveness and safety of HIV drugs comes from research done in men. This under-representation of women in studies is now changing. For more information on how The Well Project is working to advance and improve research for women living with HIV, please visit our page on the Women's Research Initiative on HIV/AIDS.
The good news is that the existing research has found little difference in terms of the effectiveness of HIV treatment for women and men. Women living with HIV who begin treatment as recommended have been found to do as well as men living with HIV. Although treatment seems to work as well in women, in some cases, the side effects may differ:
Rashes: Researchers say that women living with HIV are more likely than men to experience skin rashes from HIV drugs.
Liver problems: Women are more likely to experience liver problems as a side effect of certain HIV drugs. In fact, women with a CD4 count above 250 are warned against starting a drug combination with Viramune (nevirapine) because of the risk of dangerous liver problems.
Body shape changes: Some studies have found that women living with HIV experience different types of body shape changes than men. Women may experience more fat gain in their breasts and waists.
Weak bones: It is known that women in general are at increased risk of developing osteoporosis (weak bones) after menopause, but studies have also shown that HIV infection increases a person's risk of weakening bones. This places both men and women living with HIV at increased risk of osteoporosis. However, the risk for bone weakness in women living with HIV is three times higher than it is for men living with HIV.
Differences in side effects between men and women may be due to interactions between HIV therapy and female hormones. It may also be the result of women's smaller physical size. Standard doses of drugs are usually based upon research done mostly in men.
Women living with HIV do need to be careful about drug interactions. Certain HIV drugs can affect the levels of other drugs in the body. For example, several HIV drugs can impact the levels of birth control pills and change how effective those pills are at preventing pregnancy.
It is important for women living with HIV to be treated by health care providers with experience treating women with HIV. Tell your health care provider about all your medical conditions and any medications you are taking. If you experience side effects from your HIV drugs, be sure to ask your health care provider for help.
Certain gynecological (GYN) conditions are more common, more serious, and/or more difficult to treat in women living with HIV than in HIV-negative women:
- Some vaginal infections and inflammation, including yeast infections and bacterial vaginosis
- Common sexually transmitted diseases (STDs), such as gonorrhea, chlamydia, and trichomoniasis
- Genital herpes
- Pelvic inflammatory disease (PID)
Although little conclusive research is available on HIV and menstruation (periods), many women living with HIV report abnormal menstrual periods. Some have excessive bleeding while others stop menstruating altogether.
Human papillomavirus (HPV) is an STD that causes 99 percent of cervical cancer and can also cause genital warts. Women living with HIV are more likely to be infected with HPV than HIV-negative women. Women living with HIV are also less likely to clear, or get rid of HPV, than HIV-negative women. Women living with HIV, especially those with advanced HIV disease (lower CD4 counts), are more likely to develop dysplasia (abnormal cervical cells) as a result of HPV.
Dysplasia is a condition of abnormal cells on the cervix (the opening of the womb). It is often more severe and difficult to treat in women living with HIV than in HIV-negative women. Untreated dysplasia can lead to cervical cancer, a life-threatening illness.
It is important to find HPV early and get treatment to prevent health problems. Regular cervical screening tests are a good way to check for HPV. An abnormal cervical screening test can indicate inflammation, infection, dysplasia, or cancer in the cervix.
The US Centers for Disease Control and Prevention (CDC) recommends that:
- women living with HIV have a complete gynecological examination, including a cervical screening test, when they are first diagnosed and when they first seek prenatal care
- women living with HIV have another cervical screening test six months later
- If both tests are normal (negative), yearly screening is recommended
- Women who have had dysplasia should receive a cervical screening test more often
For more information, see The Well Project's article, Caring for a Woman's Body: What Every Woman Should Know about the Care and Prevention of GYN Problems.
There are also three effective HPV vaccines. Since the introduction of the HPV vaccines in the US four years ago, the number of 14 to 19 year old girls infected with HPV has dropped by more than half. It is important for young people to get vaccinated before they have sex (before they have been exposed to HPV), since people who are already infected with HPV are not protected by the vaccines. For more information, see our article on HPV.
With the advances in HIV care and treatment, many women living with HIV are living longer, healthier lives. As they think about the future, some of these women are deciding to have the babies they always wanted. Women living with HIV who want to be come pregnant should discuss their plans with a health care provider who is very experienced in treating women with HIV. For more information, see The Well Project's article on Getting Pregnant.
The good news is that advances in HIV treatment have also greatly reduced the chances that a mother will pass HIV on to her child (mother-to-child transmission). If the mother takes appropriate medical precautions, the rate of transmission can be reduced to fewer than five in 100 births. In addition, studies done in the US have shown that being pregnant will not make HIV progress faster in the mother. For more information on pregnancy and HIV, click here.
The numbers of women living with HIV are growing. It is important that you be aware of your risk for HIV and get tested if there is any possible reason to think you may have been exposed to HIV. In many countries, including the US, testing for HIV is part of routine health screening and preventive care.
If you test negative, you can take steps to stay that way. If you test positive, you can take steps to stay healthy and prevent passing the virus on to others, including during pregnancy. And while there is no cure yet, many women living with HIV are living longer and stronger lives thanks to effective care and treatment.
More research is needed to determine how HIV progresses in women and how HIV drugs affect women's bodies. However, it does seem that HIV drugs can benefit women as much as men. By taking advantage of good health care and treatment as soon as you can, you greatly increase your chances of living a longer and healthier life for you and your loved ones.
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