The human immunodeficiency virus is a retrovirus (Retroviridae family) that contains RNA and affects the immune system by attacking CD4+ T-lymphocytes, macrophages and dendritic cells. As the damage to the immune system progresses develops the acquired immunodeficiency syndrome (AIDS) – an advanced stage of HIV infection characterized by the body’s exhaustion and opportunistic infections.
HIV is a global spread infection. According to the WHO, approximately 36,7 million people were infected at the end of 2016. About half of them (17.8 million, which constitutes 51% of all HIV-positive individuals) were women older than 15. About 30% of infected individuals are not aware of their condition. In 2016 almost 43% of 1.8 million new HIV infections worldwide were among women. It was estimated that new infections among young females aged 15–24 years were 44% higher than they were among males in the same age group.
More than 19.5 million people (53% of all, living with HIV) were receiving antiretroviral therapy as for December 2016. Approximately 77% of pregnant woman are receiving the antiretroviral therapy.
At the beginning of the HIV epidemics almost exclusively men were affected, whereas nowadays woman, especially adolescents and young females are more likely to get infected. It was estimated that only 3 in every 10 adolescent girls and young women aged 15-24 years are enough educated and aware about HIV.
Factors associated with the increased risk of HIV
- Lack of access to health care services;
- Lack of access to education;
- Poverty and unavialability of condoms;
- Intimate violence and sexual abuse;
- Child marriage;
- Involvement in sex industry;
- Other sexually transmitted diseases;
HIV and women reproductive health
Some HIV-positive women notice the changes in their menstrual cycle. For example, the menstrual flow may change (the bleeding may be greater or lesser than usual), the periods, frequency may change or a woman may experience more painful sensations during her periods.
Women should pay attention to their reproductive health as they are predisposed to vaginal candidiasis and cervical cancer, pelvic inflammatory disease and other sexually transmitted diseases such as chlamidiosis, gonorrhea etc. A Pap test should be regularly performed to control the cervical dysplasia.
It is important to detect any gynecologic problems and start treatment immediately as such disorders are harder to treat and may have worse outcomes in HIV-positive individuals than in the general population.
Some hormonal birth control methods may interact with antiretroviral medicines, and the effectiveness of both contraceptives and anti-HIV drugs may be decreased.
Characteristic features of HIV infection in women
It is suggested that HIV affects men and women’s health differently. Women with untreated HIV are more likely to have bacterial pneumonia, recurrent herpes simplex infections and Kaposi’s sarcoma.
Antiretroviral drugs also have another impact on women than on men. Women are predisposed to develop various side effects of ART, for example rash and allergic reactions. Women may experience fat gain in the breasts and stomach due to lipodystrophy and lipoatrophy. Anemia and bone loss are also more common for females.
The transmission of HIV during pregnancy is relatively rare (especially if the mother-to-be receives antiretroviral treatment) as the mother’s blood and the blood of the fetus do not mix. When the prophylactic antiretroviral therapy is not administered to the mother during pregnancy, labor, and delivery, and to the fetus after birth, the possibility of HIV transmission from mother to infant/fetus is from 15 to 35% depending on the country.
Monotherapy with zidovudine is considered to be totally safe for the child. It is believed that when a mother-to-be receives appropriate treatment during pregnancy the risk of HIV transmission to the fetus is reduced to 2%.
The highest risk (50-65%) of infecting the child occurs during vaginal delivery, so the Cesarean section is recommended to protect the child.
Breast milk contains viruses, so it may be dangerous for a newborn to be fed by breastfeeding. Breastfeeding drastically increases the risk of HIV transmission from mother to child. Transmission ranges from 14% to 25% in Europe and America and from 13% to 42% in developing countries when no prevention measures are taken.
It is better to avoid breastfeeding if a child has not been infected before. Formula feeding is recommended. When formula milk is not available the baby should be exclusively breastfed until the age of 6 months with early cessation. Wet-nursing by a non-infected woman may be an option as well.