MANAGEMENT OF THE FEMALE HIV-INFECTED PATIENT

Management of women with HIV infection or AIDS should follow the established guidelines for antiretroviral therapy and prevention and treatment of opportunistic complications of HIV infection. Gynecological manifestations of HIV are primarily cervical dysplasia and cancer associated with human papillomavirus (HPV) infection and vaginal and mucocutaneous candidiasis. Human papillomavirus-associated cervical dysplasia/neoplasia is more common in women with advanced rather than early HIV disease, and monitoring with Pap smears should probably increase to every 6 months in patients with CD4(+) cell counts <500 cells/mu l (and certainly when this value falls below 200), with positive Pap smears confirmed by colposcopy and biopsy. For patients with CD4(+) cell counts >350 cells/mu l, cryotherapy is probably adequate, but therapy should be increasingly aggressive at lower CD4(+) cell counts. Results of ongoing studies should be available soon to guide therapy. Optimal treatment of candidiasis in HIV-infected women includes prevention of recurrence with a combination of topical and systemic antifungal agents. Women with child-bearing potential should be treated as medically indicated for other HIV-infected patients, including during pregnancy. In fact, preliminary results of ACTG 076 indicated that zidovudine therapy during pregnancy reduces vertical transmission of HIV about threefold.