Women and HIV infection

The pattern of the AIDS epidemic has recently changed with proportionately more women and children affected. Cases are becoming more widespread and heterosexual encounters are becoming an important means of spread of disease (presently 43% of all cases in the United States). Risks of contracting the virus depend upon sexual behaviors and the status of HIV disease in her partner. Manifestations of HIV infection are varied in women and include infections and cancer. Once the patient tests positive for HIV infection, she needs serial screening of blood counts, CD4 lymphocyte subsets and measurements of viral burdens. Antiretroviral therapy should be started when the CD4 count drops to under 500/d1, and prophylaxis against pneumocystis carinii and also for viral and mycobacterium avium infections when the CD4 count drops under 200/d1 and 100/d1 respectively. Pregnant women have a 25-33% risk of transmitting the disease to their fetus; this can be reduced through AZT treatment of the mother and of the baby after birth. Risk reduction through counseling about safer sex, e.g., abstinence, condom use, remains the best hope for protecting women against the HIV epidemic.