HIV Infection in Women

by Lynae Brayboy, MD

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    00:01 Hi! today we're gonna discuss gynecologic care of the HIV-infected woman.

    00:08 HIV in the US accounts for about 900,000 people living with HIV.

    00:16 Heterosexual contact is the most common way for HIV transmission to women in the US, at least.

    00:23 About 23% of these women will be exposed to HIV through injection drug use and about 2% will have perinatal infection which is to say that the infection is passed from the mother to the baby.

    00:37 In the US we have a disproportionate amount of women who are African-American and Latina or "Latinx" who account for 78% of HIV infected women.

    00:48 It's important to know that most women are diagnosed during their reproductive years with HIV.

    00:53 This is the time when they'd be seeing a obstetrician gynecologist or primary care provider.

    00:59 HIV infected women are increased risk of persistent and recurrent vaginitis, usually caused by bacterial vaginosis or candida albicans.

    01:11 Women who have HIV have higher rates of cancer of the vagina, the vulva and peri-anal region.

    01:18 Their cancer also tends to be very high grade compared with the general population.

    01:23 Now let's discuss the management of non-pregnant women who are HIV positive.

    01:28 Let's review how sexually transmitted infection should be managed.

    01:32 First though, let's discuss PrEP.

    01:34 And PrEP is pre-exposure prophylaxis.

    01:37 Usually that's an anti-retroviral medication that is given to the partner of an HIV positive woman.

    01:44 Herpes simplex virus prophylaxis is also given to HIV positive women to improve their chances of not having severe HSV outbreaks.

    01:55 Also women who are HIV positive need to be screened for syphillis at the entry of care and at least annually thereafter.

    02:05 Let's talk about the goals for the management of the non-pregnant woman who's HIV-positive.

    02:11 So the number one goal for anti-retroviral therapy is to achieve a fully suppressed HIV viral load for their own benefit and long-term health.

    02:22 and the second goal is to decrease transmission to uninfected partners.

    02:29 In terms of cervical screening, normally we start at the age of 21 years old in the average general population.

    02:36 However, HIV-positive women should begin within one year of onset of sexual activity.

    02:43 If already sexually active, it should happen within the first year of HIV diagnosis.

    02:49 No later than 21 years of age should they commence doing PAP smears and continue throughout life, not stopping at 65 years old as in the general population.

    03:01 In terms of contraceptives of women who have HIV, we recommend that women actually use copper IUDs or intra-uterine devices or levonorgestrel-releasing IUDs.

    03:12 And those can both be safely used in HIV-positive or HIV infected women.

    03:18 Hormonal contraception is also considered safe for use by HIV-positive women and those who are taking antiretroviral therapy.

    03:28 Another alternative that is a more long acting medication is depot medroxyprogesterone acetate and this can be prescribed to women who have HIV.

    03:38 It's considered MEC category 1.

    03:42 In terms of other contraceptive choices, it's important to remember to avoid vaginal spermicides such as Nanoxynol-9 which actually may increase the risk of HIV transmission due to vaginitis.

    03:56 I just want to point out to you one high-yield fact in the care of HIV-positive women and that is stopping transmission.

    04:03 Women with HIV should be screened for high risk behaviors and offered interventions.

    04:09 We know that high risk behaviors including sexual and drug behaviors can lead to increased transmission of HIV.

    04:18 So just to remember: African-Amercian and Latina or Latinx women are increased risk for HIV infection.

    04:25 Partners of HIV infected women should use PrEP.

    04:29 HIV infected women should be offered intra-uterine devices such as the copper IUD or the levonorgestrel IUD And women should be encouraged to use condoms and hormonal contraception.

    04:41 Discourage women from partaking in high-risk behaviors that can lead to increased transmission.

    04:48 Thank you for listening and good luck on your exam.

    About the Lecture

    The lecture HIV Infection in Women by Lynae Brayboy, MD is from the course Gynecologic Pathology: Infections, Neoplasms and Screening.

    Included Quiz Questions

    1. Stopping the PAP screening after 65 years of age
    2. Screening with PAP smear should begin within one year of onset of sexual activity
    3. If the patient is already sexually active within the first year after HIV diagnosis
    4. Screening should begin no later than 21 years of age
    5. Screening with PAP smear must be throughout life
    1. Spermicidal jelly
    2. Hormonal IUD
    3. Oral contraceptives
    4. Condoms
    5. Depot medroxyprogesterone acetate
    1. African American women
    2. Caucasian women
    3. Japanese women
    4. Middle eastern women
    5. Chinese women

    Author of lecture HIV Infection in Women

     Lynae Brayboy, MD

    Lynae Brayboy, MD

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