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Section Two: Special Situations

Part Two of Three in Project Inform's "What You Should Know About When to Start and What Meds to Use" Booklet

January 2013

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If You Are an HIV-Positive Woman

If You Are an HIV-Positive Woman

Not all HIV meds have been studied as well in women. For instance, it's not always well understood how female hormones interact with HIV meds. Despite this, treating HIV is pretty much the same for women and men, aside from the areas described below.

However, what often isn't talked about in a doctor's office are the things that can get in the way of women taking good care of their HIV and general health. Many women look after other people first before doing those key things that keep them healthy. This includes taking meds, getting to regular doctor visits, eating well, getting good sleep, and keeping active with hobbies.

If this sounds like your life, then it opens you up to some of the issues detailed in other parts of this booklet. The bottom line: your health matters. And if you're taking the best care of yourself as you possibly can, then you're also probably doing the best for others in your life.


Many HIV meds, mostly protease inhibitors and NNRTIs, can interact with hormonal birth control pills (those with ethinyl estradiol, norethindrone). These interactions can change how well the birth control pill or HIV meds do their jobs. In this case, women may consider other HIV meds or use another form of birth control instead of, or in addition to, the pill.

Periods and Menopause

Heavy, painful or irregular periods may occur with some HIV meds, including some protease inhibitors. Report any changes you notice to your doctor.

Women can lose about 5% of their bone mass during menopause. Combine that with the bone loss that can happen from taking HIV meds, from aging or from being inactive, and this can lead to fractures and broken bones. Talk to your provider about your options for prescriptions that help maintain bone health.

Some studies show that women with more advanced HIV disease may go through menopause at an earlier age, although other studies do not.



We know a great deal about how to safely prevent HIV being passed during pregnancy and birth. The topics below should be considered and discussed with your doctor when taking HIV meds leading up to and during pregnancy.

Ensuring the mother's health:

  • The US Guidelines recommend all HIVpositive pregnant women be on treatment, regardless of CD4 count or viral load.
  • Find a doctor who is experienced with HIV and pregnancy.

Protecting the baby:

  • Some doctors recommend that women with early HIV disease not start treatment during their first trimester, when the baby's organs are developing.
  • Sustiva (Atripla) should not be used while the woman is trying to get pregnant and after getting pregnant, due to a risk of birth defects. If a woman has to use Sustiva, it's best to wait until the second trimester to start.

Choosing meds:

  • Some HIV meds may worsen conditions that are commonly seen during pregnancy, such as diabetes.
  • If protease inhibitors are used, their dose may need to be increased during the third trimester.
  • Starting Viramune may cause severe liver disease when CD4s are above 250.
  • Retrovir is normally used to help prevent transmission, unless the woman develops severe side effects, or is resistant to it.
  • Retrovir+Zerit and Videx+Zerit should not be used.



Whether or not the woman is taking HIV meds, the virus can be found in breast milk and may be passed to the child during breast-feeding. HIV meds may also be passed. Therefore, the US Guidelines recommend that mothers use formula to feed newborns. Women should consult experienced maternity doctors to figure out their options. Accredited national or local breast milk banks may also help and may meet the infant's need for breast milk.

If You Drink Alcohol Regularly or Use Recreational Drugs

It's not uncommon for people to drink or use recreational drugs. For some, this isn't an issue for them socially or medically. However, drinking or using drugs can change how well your HIV meds work.

If You Drink Alcohol Regularly or Use Recreational Drugs

Most health care providers recommend that the average man should have no more than two drinks per day. Women should have no more than one.

People who drink more than that -- or who binge (4 drinks for women and 5 for men within 2 hours) -- are at a higher risk for accidents, STDs, mental health problems, and diseases of the liver, heart and brain. As for recreational drugs such as ecstasy and ketamine, they can cause severe reactions with HIV meds, including heart attacks, hepatitis, paranoia and death.

That all probably sounds alarming, but we've mentioned it because it's a real issue for some people. As well, there are other reasons why it's important for HIV-positive people to drink responsibly and to limit their drug use, which includes what's below.


If you drink regularly or use drugs, you will probably have a harder time remembering to take your meds. As we've mentioned often in these booklets, not taking your HIV meds as prescribed can cause them to stop working and limit your treatment options.

Liver Disease

On its own, HIV can be hard on the liver. And 1 out of 4 HIV-positive people also have hepatitis C, which can greatly hurt liver health as well. Adding alcohol or certain recreational drugs can make things even worse. You can help your liver stay healthier longer by not using drugs or not drinking too much or any alcohol.

If you're not successful with cutting down or cutting out your alcohol or drug intake on your own, ask your health care provider or case manager for help. There are many kinds of programs that can support you while you stop drinking or drugging.

Main Points to Remember

  • Drinking alcohol or doing recreational drugs can make you forget to take your meds on time.
  • Some recreational drugs can cause very harmful interactions with HIV meds.
  • Alcohol and street drugs can be very hard on the liver.
  • Seek support programs to quit drinking or doing drugs.
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More From This Resource Center

10 Questions to Ask Yourself Before You Begin HIV Treatment

Are Your HIV Meds Working? Warning Signs and False Alarms

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"Now That You've Started Treatment": Table of Contents
Section One: What Everyone Should Know

This article was provided by Project Inform. Visit Project Inform's website to find out more about their activities, publications and services.

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