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.
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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.
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However, HIV-positive women should begin
within one year of onset of sexual activity.
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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.
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It's considered MEC category 1.
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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.
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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.
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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.