Hi! today we're gonna discuss gynecologic
care of the HIV-infected woman.
HIV in the US accounts for about
900,000 people living with HIV.
Heterosexual contact is the most common way for
HIV transmission to women in the US, at least.
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.
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.
It's important to know that most women are diagnosed
during their reproductive years with HIV.
This is the time when they'd be seeing a
obstetrician gynecologist or primary care provider.
HIV infected women are increased risk
of persistent and recurrent vaginitis,
usually caused by bacterial
vaginosis or candida albicans.
Women who have HIV have higher rates of cancer
of the vagina, the vulva and peri-anal region.
Their cancer also tends to be very high
grade compared with the general population.
Now let's discuss the management of
non-pregnant women who are HIV positive.
Let's review how sexually transmitted
infection should be managed.
First though, let's discuss PrEP.
And PrEP is pre-exposure prophylaxis.
Usually that's an anti-retroviral medication that
is given to the partner of an HIV positive woman.
Herpes simplex virus prophylaxis is
also given to HIV positive women
to improve their chances of not
having severe HSV outbreaks.
Also women who are HIV positive
need to be screened for syphillis
at the entry of care and at
least annually thereafter.
Let's talk about the goals for the management
of the non-pregnant woman who's HIV-positive.
So the number one goal for anti-retroviral therapy
is to achieve a fully suppressed HIV viral load
for their own benefit and
and the second goal is to decrease
transmission to uninfected partners.
In terms of cervical screening, normally
we start at the age of 21 years old
in the average general population.
However, HIV-positive women should begin
within one year of onset of sexual activity.
If already sexually active, it should happen
within the first year of HIV diagnosis.
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.
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.
And those can both be safely used in
HIV-positive or HIV infected women.
Hormonal contraception is also considered
safe for use by HIV-positive women
and those who are taking antiretroviral therapy.
Another alternative that is a more long acting
medication is depot medroxyprogesterone acetate
and this can be prescribed
to women who have HIV.
It's considered MEC category 1.
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.
I just want to point out
to you one high-yield fact
in the care of HIV-positive women and
that is stopping transmission.
Women with HIV should be screened for high
risk behaviors and offered interventions.
We know that high risk behaviors
including sexual and drug behaviors
can lead to increased
transmission of HIV.
So just to remember:
African-Amercian and Latina or Latinx women
are increased risk for HIV infection.
Partners of HIV infected women
should use PrEP.
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.
Discourage women from partaking in high-risk
behaviors that can lead to increased transmission.
Thank you for listening and
good luck on your exam.