November 29, 2010
The American College of Obstetricians and Gynecologists recently issued guidelines for the routine gynecological care of HIV-positive women. "Most of the women living with HIV today in the US are in their prime reproductive years," noted Dr. Hal C. Lawrence, vice president of practice activities for ACOG.
All women ages 19 to 64 should receive routine HIV screening, the report recommended. While there is no consensus on how often repeat screening should be offered, the guidelines suggested at least annual testing for women at elevated risk, including injection drug users, those whose partners are injection drug users or HIV-positive, and those have had an STD in the previous year.
The guidelines recommend aggressive treatment of STDs, which increase the risk of HIV transmission. CDC recommends annual testing for curable STDs, ACOG noted. HIV-positive women should have cervical screening twice during the first year after HIV diagnosis and annual screening thereafter.
HIV-positive women are at increased risk of bacterial vaginosis and yeast infections, and treatment may take longer than average, the guidelines note. Women with recurrent yeast infections may need long-term medication to forestall future yeast infections, they said.
Condoms, which are recommended for all sexually active HIV-positive persons, plus another method of birth control are recommended to prevent unintended pregnancy among HIV-positive women of child-bearing age. Oral contraceptives are safe for women with HIV, but combined oral contraceptives generally are not recommended for women taking certain antiretroviral therapy, as the medications can interfere with each other. ACOG notes that IUDs can be a good birth control option for HIV-positive women.
Strategies are available for HIV-positive women who wish to become pregnant to avoid the risk of vertical transmission. They include reducing the virus to undetectable levels before delivery, not breastfeeding, and administering the infant prophylactic antiretrovirals.
HIV-positive women tend to go through menopause about three to four years before other women, according to the guidelines. In the absence of detailed research, the guidelines suggest standard interventions to address the bone loss often seen in menopausal women: increasing physical activity, stopping smoking, and taking vitamin D and calcium supplements.
The full report "Practice Bulletin No. 117: Gynecologic Care for Women with Human Immunodeficiency Virus," was published in Obstetrics & Gynecology (2010;116(6):1492-1509).