HIV Infection in Women

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.