HIV in Women and Child

Many women think AIDS is a disease of gay men.
But women get HIV from sharing needles and from heterosexual sex. Heterosexual sex is a growing source of HIV infection in women.

During sex, HIV is transmitted from men to women much more easily than from women to men.

A woman's risk of infection is higher with anal intercourse, or if she has a vaginal disease.

Women should know the HIV risk factors for their sex partners.

The risk of infection is higher if your sex partner is or was a user of intravenous drugs, has other sex partners, has had sex with infected people, or has sex with men. Talk about these risk factors and take steps to protect yourself.

If you are not absolutely certain about your sex partner's HIV status, take precautions.

Using a condom correctly can prevent most cases of HIV infection. Use only water-based lubricants, because oils can weaken condoms and they may break. Do NOT use Vaseline, cold cream, baby oil, or shortening. The creams or lotions used to treat yeast infections or other vaginal infections can also weaken condoms.

Many women feel they cannot ask their boyfriends or husbands to use condoms.
But condoms are the safest way to avoid HIV infection. There is a female condom that provides some protection, but not as much as a male condom. Other forms of birth control, such as birth control pills, diaphragms, or implants do NOT provide protection against HIV.

Get tested for HIV if you think a sex partner might be at risk.
Many women don't find out they have HIV until they become ill or get tested during pregnancy. If women don't get tested for HIV, they seem to get sick and die faster than men. But if they get tested and treated, they live as long as men.

Viral loads are different in women.

A study published in late 1998 showed that women with half the viral load of men developed AIDS in the same length of time as the men.

Vaginal problems can be early signs of HIV infection.

Ulcers in the vagina, or yeast infections that come back within 2 months and don't clear up easily, can be signs of HIV. Hormone changes, birth control pills, or antibiotics can also cause them. See your doctor to make sure you know the cause.

Mothers can pass HIV infection to their babies.

When a woman with HIV gets pregnant, she can pass HIV to her unborn child. Also, a mother's breast milk can infect her new baby. Treatment with the drug AZT during pregnancy, and for the newborn, can reduce the child's risk of infection from 25% to 8%.

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WHAT DO RESEARCHERS NEED TO KNOW?

More women need to be studied. Only 10% of the people in AIDS research studies have been women. Now, more women are being studied, and in 1994, researchers started studies of almost 3,000 HIV-positive and 1,000 HIV-negative women. Also, in 1997 the FDA said that women could no longer be kept out of clinical trials just because they might become pregnant.

Some HIV-related diseases are different in women.

Women get vaginal infections, genital ulcers, pelvic inflammatory disease, and genital warts more often - and more severely - than uninfected women.

Cervical cancer was added to the list of HIV-related infections in 1993. HIV-infected women should get pap and pelvic exams at least once a year. Only 1 woman gets Kaposi's sarcoma, a skin cancer , for every 8 men who get it.

Women get thrush (a fungal infection) in their throats and herpes (a virus that causes cold sores and genital herpes) about 30% more often than men.

Women with fat redistribution are more likely than men to accumulate fat in the abdomen or breast areas and are less likely to lose fat in the arms or legs.

More research is needed on how HIV medications affect women.

Most HIV medications have not been studied to see if they affect women differently, if they affect menstrual cycles, or if they interact with birth control medications. Nevirapine, ritonavir, and nelfinavir reduce the effectiveness of birth control pills.

THE BOTTOM LINE

More women are becoming infected with HIV. With early testing and treatment, women can live with HIV as long as men. Women need to know more about how they can be infected, and should get tested for HIV if they think there is any chance they have been exposed. This is especially true for pregnant women. If they test positive for HIV, they can take steps to reduce the risk of infecting their babies.

The best way to prevent infection in heterosexual sex is with the male condom. Other birth control methods do not protect against HIV. Women who shoot drugs should not share needles, or should learn how to clean them. Women should discuss vaginal problems with their doctor, especially yeast infections that don't go away or ulcers. These could be signs of HIV infection.

CHILD/INFANTS:

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HOW DO BABIES GET AIDS?

The virus that causes AIDS, HIV, can be transmitted from an infected mother to her newborn child. Without treatment, about 26% of babies of infected mothers get infected.

Mothers with higher viral loads are more likely to infect their babies.

However, no viral load is low enough to be "safe". Infection can occur any time during pregnancy, but usually happens later in pregnancy or during delivery.

The baby is more likely to be infected if the delivery takes a long time.

During delivery, the newborn is exposed to the mother's blood.

Drinking breast milk from an infected woman can also infect babies.

Mothers who are HIV-infected should not breast-feed their babies.

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HOW CAN WE PREVENT INFECTION OF NEWBORNS?

Mothers can reduce the risk of infecting their babies if they:

Use AZT OR nevirapine
Keep the delivery time short, and
Don't breast-feed the baby

Use AZT: The risk of transmitting HIV drops from 25% to 8% if:

The mother takes the antiviral drug AZT during the last six months of her pregnancy, and
The newborn takes AZT for six weeks after birth.
Even if the mother does not take AZT, the risk of transmission is less if the baby is given AZT within two days of birth.

Use nevirapine:

Scientists found that nevirapine can work even better than AZT where women breast-feed their babies. The mother gets one dose when she arrives at the hospital in labor, and the newborn gets one dose within the first three days of life. Thirteen percent of newborns were HIV-positive at four months of age.BUT check with your doctor first

This approach could be very beneficial in our country.

Keep delivery time short:

The risk of transmission increases with longer delivery times. If the mother uses AZT and delivers her baby by cesarean section (C-section), she can reduce the risk of transmission to about 2%.

Do not breast-feed the baby:

There is about a 14% chance that a baby will get HIV infection from infected breast milk. This risk can be eliminated if HIV-infected women do not breast-feed babies.

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HOW DO WE KNOW IF A NEWBORN IS INFECTED?

Most babies born to infected mothers test positive for HIV. Testing positive means you have HIV antibodies in your blood. Babies get HIV antibodies from their mother even if they aren't infected with the virus.

If babies are infected with HIV, their own immune systems will start to make antibodies. They will continue to test positive. If they are not infected, the mother's antibodies will gradually disappear and the babies will test negative after about 6 to 12 months.

Another test, similar to the HIV viral load test can be used to find out if the baby is infected with HIV. Instead of antibodies, these tests detect the HIV virus in the blood.

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WHAT ABOUT THE MOTHER'S HEALTH?

Recent studies show that HIV-positive women who get pregnant do not get any sicker than those who are not pregnant. That is, becoming pregnant does not appear to be dangerous to the health of an HIV-infected woman.

However, while AZT can reduce the risk of transmission, it may not be the best choice for the mother's health. The new combination therapies work better for people who have never taken any antiviral drugs. If a pregnant woman takes AZT, she may get less benefit from combination therapy in the future.

On the other hand, taking combination therapy during pregnancy might cause birth defects. Early studies suggest that pregnant women who take combination antiviral therapy are more likely to deliver their babies prematurely.

Some medications used to treat HIV and opportunistic infections can cause birth defects, especially if they are used during the first three months of pregnancy.

If you have HIV and you are pregnant, or if you want to become pregnant, talk with your doctor about your options for taking care of yourself and reducing the risk of danger to your new child.

THE BOTTOM LINE

An HIV-infected woman who becomes pregnant needs to think about her own health and the health of her new child. The risk of transmitting HIV to a newborn can be cut to just 2% if the mother takes AZT during the last 6 months (there are different options best to consult your doctor) of her pregnancy, delivers her child by Cesarean section, and the newborn takes AZT for six weeks (consult your doctor).

Pregnancy does not seem to make the mother's HIV disease any worse.

However, some medications used to fight HIV or to treat opportunistic infections might cause birth defects (consult your doctor). This is especially true during the first 3 months of pregnancy. If a mother chooses to stop taking some medications during pregnancy, her HIV disease could get worse.

Any woman with HIV who is thinking about getting pregnant should discuss treatment options with her doctor.

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WHAT IS IMMUNE RESTORATION?

Immune restoration refers to repairing the damage done to the immune system by HIV.

In a healthy immune system, there is a full range of T-cells (CD4+) that can fight different diseases. As HIV disease progresses, the number of T-cells drops. The first T-cells that HIV attacks are the ones that specifically fight HIV. Some types of T-cells can disappear, leaving gaps in the immune defenses. Immune restoration looks for ways to fill these gaps.

A healthy immune system can fight off opportunistic infections (OIs). Because these infections develop when T-cell levels are low, many researchers think that we can use T-cell counts as a measure of immune function. They believe that increases in T-cell counts are a sign of immune restoration.