The number and proportion of women infected with the human immunodeficiency virus (HIV) and with the acquired immunodeficiency syndrome (AIDS) have increased rapidly throughout the last decade. Despite these increases, the scientific community has focused limited research attention on women living with HIV infection. Data from studies of predominantly gay/bisexual men may not reliably be extended to women; studies of the natural history of HIV infection in women are needed. Obstetrician-gynaecologists are increasingly called upon to diagnose HIV infection in women and provide care in both clinical and research settings. In this review we discuss the serodiagnosis of HIV infection in women; the impact of pregnancy on HIV disease progression; transmission of HIV infection from mother to offspring; gynaecological infections and malignancies which may manifest differently in HIV-infected women; and clinical care of women living with HIV.
PIP: More than 50% of US women with AIDS live in New York City, Newark, Baltimore, and Washington, D.C. Most are of reproductive age. About 75% are Black or Hispanic. Few women are part of AIDS clinical trials. A mix of socioeconomic and demographic factors prevent HIV-positive women from receiving optimal care and being part of research. Researchers has not observed these barriers earlier in the AIDS epidemic. Obstetrician-gynecologists (OB/GYNs) are often the first health providers to diagnose and treat HIV infection since HIV-infected women have a high rate of gynecological infections and malignancies. Many women first learn their HIV status after being treated during pregnancy. Many HIV-infected women have no perceived risk factors and have acquired HIV via heterosexual transmission. HIV infection does not appear to reduce fertility, adversely affect pregnancy outcome, or cause menstrual disturbance. Some physicians suggest that HIV testing should be offered to all pregnant patients, women using IV drugs, women with malignant and premalignant lesions of the genital tract and high-risk behavior, and women with tuberculosis or severe bacterial infections. The risk of sexual transmission of HIV from male to female is 2-16 times greater than it is from female to male. HIV prevalence in postpartum women in some hospitals in some large US cities is as high as that in central Africa. The US vertical transmission rate ranges from 15 to 30%. Essential to improving the situation are: cooperation among researchers to promote studies for and about women, independent of their role in transmitting HIV to partners or children; clinicians mastering their prejudices and abiding by the highest standards of care; and a public policy which upholds reproductive choice for all women regardless of their HIV status. OB/GYNs will be summoned more and more to lead efforts to eliminate barriers to improve care and research.