HIV infection in women

Abstract

Human immunodeficiency virus (HIV) infection is caused by an RNA retrovirus. The virus is trophic for CD 4 lymphocytes. By attacking and ultimately destroying these cells, the virus causes a severe deficiency in cell-mediated immunity, rendering the host susceptible to a myriad of opportunistic infections and malignancies. HIV infection occurs in a continuum, ranging from the initial, acute retroviral illness to florid acquired immunodeficiency syndrome (AIDS). At the present time, more than 400,000 Americans have been afflicted with AIDS. Approximately 1 million Americans are in pre-AIDS stages of their illness. In the United States, 12–15% of patients with HIV infection are women. Among women, the two most important risk factors for HIV infection are intravenous drug use and heterosexual contact with a high-risk male. Factors that increase the risk of sexual transmission of HIV infection include multiple partners, receptive anal intercourse, concurrent use of intravenous drugs or crack cocaine, and ulcerated genital tract lesions. Approximately 90% of all cases of HIV infection in children result from direct perinatal transmission from an infected mother. Transplacental dissemination and intrapartum transmission are the two most important mechanisms of perinatal infection. HIV infection can also be transmitted by breast-feeding and by close personal contact following delivery. The approximate frequency of perinatal transmission is 20–30%. The risk of transmission can be reduced significantly by treating HIV-infected patients and their neonates with zidovudine. Because HIV infection is such a severe and, usually, fatal illness, great emphasis should be placed on preventive measures.