The Clinical Course of HIV Infection in Women

Abstract

Abstract Women account for a growing proportion of HIV infection in the United States as injection drug use and heterosexual contact become the predominant modes of HIV transmission. In seroprevalence studies of inner-city populations, the female-to-male ratio of HIV seropositivity approaches 1:1. In 1991, 74% of reported AIDS cases in women were among African-American and Hispanic women.AIDS is the fourth leading cause of death among women of childbear ing age nationallyand the leading cause of death among women of childbearing age in several urban areas. Recognition of early manifestations of HIV disease in women is essential for the initiation of antiretroviral and chemoprophylactic therapy since the effective ness and tolerance of many therapeutic regimens diminishes with advanced HIV disease.Until recently, however, manifestations of HIV that may be unique to, or more prevalent in, women have not been studied. The primary focus of research in HIV-infected women has been vertical transmission, examining rates of transmission of HIV from mother to child during pregnancy. Frequently, HIV infection in women is identified through routine prenatal screening in areas of high HIV infection, where a majority of women are unaware of exposure to HIV.7 Despite the high prevalence of gynecological manifestations in women, HIV infection often remains undiagnosed until advanced immunodeficiency is present since clinicians may not suspect HIV when women present with gynecological complications.