Questions About HIV/AIDS in Women

The other day I was looking through some of my old newsletters, when I came upon an article written by an old friend of mine, Lori Levine. Lori, rest her soul, was very verbal about HIV and AIDS. She actually started the Women's Column in the "Being Alive Newsletter" which eventually expanded into the "Women Alive Newsletter". Lori's articles were always pointed and sometimes ironically truthful. She had questions and wanted answers- NOW!

Five years ago, the article which grabbed my attention was titled "Questions about HIV/AIDS in Women". In this article, Lori posed 18 questions about how HIV/AIDS manifests itself in women and the effect of treatments on women. This article is now five years old, and although a few of these questions have been answered, the majority have not. In fact, we have even more questions, because there are more infected women and more treatment options. word of mouth Women continue to receive the majority of their information anecdotally. That is, from support groups, phone conversations with other HIV positive women, and through newsletters like this one.

Several of Lori's questions were about the menstrual cycle. Such as:

• How does the menstrual cycle affect the action of medications (e.g., in possible anemia, fatigue, etc.)? Specifically, in terms of particular drugs?
• Why are most HIV+ women having much worse PMS than they did before they were infected?
• Why are most HIV+ women bleeding much less during menstruation?
• Why are our menstruation cycles getting much stranger?

To which I'd like to add a couple questions of my own:

• Why do so many HIV+ women have early menopause? I've known women in their early 30's who have gone through menopause.
• Should HIV+ menopausal women be on hormone therapy or not? Many of us already take many, many drugs, and the thought of adding another one makes us want to gag. But, if HIV is speeding up the aging process, then would the hormones help our immune system stay strong? Let's face it, menopausal HIV+ women are probably not at the top of the AIDS research food-chain. But, hey, can't somebody with some medical knowledge at least think about it?

One highly respected Los Angeles gynecologist, does recommend that HIV+ menopausal women use estrogen replacement therapy because lack of estrogen can cause a weakening of the vaginal tissue, leaving women more susceptible to infections.

Here's another good question Lori asked: Very often, just prior to or during menstruation an outbreak of herpes occurs. Is it possible that, as the immune system is weakened enough to promote a herpes outbreak during menstruation women become more susceptible to opportunistic infection?

And this: Which treatments may cause vaginal thrush (yeast infections) in women?

My addition is: Why are so many women routinely being prescribed broad spectrum antibiotics as PCP prophylaxis when these antibiotics often cause yeast infections? Aren't chronic yeast infections incredibly immune suppressive? Would not, perhaps, aerosolized pentamidine be a better treatment option for women, even though it is less effective against PCP than bactrim and dapsone?

Which leads to Lori's: How does vaginal thrush respond to the oral antifungals?

My turn: So, should women take anti-fungal medications like flu-conozole to get rid of the yeast created by the antibiotics? While this may help with the yeast infection, it could cause resistance to fluconozole and later in the disease, when a strong anti-fungal is really needed, it won't help. Seems to me like a lot of drugs to take to try to prevent a disease that may never happen. I've been plagued with yeast infections since I was first infected, and they are a complete drag! Not to mention the fatigue aspect that accompanies them. And now many of us are taking two anti-virals and a protease inhibitor. Perhaps our overworked livers won't be able to take all these drugs. I know that I'm concerned.

Back to Lori: Are there any differences in how women respond to drug treatments with regards to differences in efficacy and side effects?

And now, we have a new class of drugs, protease inhibitors which again, anecdotal reports are all we are getting when it comes to women. We hear at Women Alive that no women have been able to tolerate the Abbott protease inhibitor, Ritonovir. I didn't hear about that when I went to Abbott's presentation last month in Los Angeles. Hmmmmm.

And in 1991 Lori asked: Which drug protocols include women? Which do not, and why?

While it seems some attempts are being made to include women in trials, this is still a relevant question in 1996. What is disheartening is that so many of the questions Lori posed so many years ago are still being asked today. Lori's last question was: How many women will be HIV+ by the year 2000? That question has definitely been answered. Far, far too many.