Contemporary issues in gynecologic and reproductive health for women with HIV

Women with HIV (WWH) face unique gynecologic and reproductive health challenges related to HIV infection itself, antiretroviral therapy (ART) and medication-interactions with ART.

WWH experience higher incidence of co-infection with many sexually transmitted infections (STIs), including hepatitis and human papilloma virus (HPV)-related dysplasia and cancers. Regular preventive care and vaccination are key. WWH additionally experience higher rates of unplanned pregnancy than the general population, with a high unmet need for contraception. For WWH in mixed-status relationships who desire conception, there is a shift towards preexposure prophylaxis and treatment as prevention, and away from older assisted reproductive interventions, such as sperm washing. ART is well tolerated and critically important in both pregnancy and breastfeeding, for both maternal health and prevention of perinatal transmission. Given the emergence of increased safety data for breastfeeding in the setting of perinatal and postpartum transmission, the United States guidelines have shifted to recommend shared decision making around infant feeding.

Recommendations to optimize gynecologic and reproductive healthcare for WWH include patient centered counseling, shared decision making, and access to the full spectrum of treatment and prevention options, integrated into HIV care.