HIV and Women's Health

Some STIs affect women with HIV differently than women who do not have HIV. These include:

• Genital herpes. Outbreaks of herpes sores can last longer and happen more often in people with HIV and may be more severe and painful. The sores may be worse when CD4 cell counts are low. Herpes sores can be treated, and medicine can help prevent future outbreaks. But this may not work as well as in women with HIV, who may also develop resistance to the herpes medicine.
• Chancroid. Chancroid (SHAN-kroid) is less common in the United States. It begins with open sores on the genitals. You may not notice the sores, and you may not have other symptoms. Symptoms can include pain when urinating or having bowel movements, painful sex, rectal bleeding, or vaginal discharge. Many medicines are used to treat chancroid. For women with HIV, the ulcers may heal more slowly or may need to be treated more than once.
• Pelvic inflammatory disease (PID). PID is an infection of a woman's pelvic organs (uterus, fallopian tubes, and ovaries). In women with HIV, PID may be harder to treat, may not go away, or may come back over and over again as a woman's immune system weakens. PID can make it harder to get pregnant.

Cervical cancer is called an AIDS-defining cancer. That means, in women with HIV, a diagnosis of cervical cancer marks the point at which HIV has progressed to AIDS.1 The abnormal cervical cells that lead to cervical cancer are caused by human papillomavirus (HPV). The types of HPV that cause cervical cancer are more common in women who are HIV-positive. Women with HIV need regular Pap tests to help find changing cervical cells before they turn into cancer. Get a Pap test two times during the first year after you're diagnosed with HIV. If results are normal, get a Pap test once a year. If results are not normal, talk to your doctor about how often you should get a Pap test and the next steps to take. Researchers are studying whether medicine to treat HIV also might lower the risk of developing cervical cancer.

A vaginal yeast infection is an infection of the vagina that causes itching and burning of the vulva. Recurring yeast infections (at least four times a year) happen more often in women with advanced HIV or AIDS. Vaginal yeast infections are common and easily treated in most women, but can happen more often and may be harder to treat in women with HIV.

Bacterial vaginosis (BV) is a vaginal infection that is caused by changes in the amount or balance of bacteria normally found in the vagina. BV is more common in women with HIV and may be harder to treat.

Women with HIV may have more menstrual problems than other women. You may have lighter or heavier bleeding, missed periods, and more severe premenstrual syndrome.

These problems may be caused by other factors that are more common in women with HIV — such as sexually transmitted infections (STIs) or stress — rather than by the infection. But the change in your immune system could affect your hormones and cause problems with your period. Weight loss, chronic disease, drug abuse, birth control, HIV drugs, uterine fibroids, itching, genital tract infections, and perimenopause can all cause menstrual problems.

Talk to your doctor or nurse about any menstrual problems.

Some medicines can interact with HIV drugs. These interactions can hurt you or make the HIV medicines weaker. You should tell your doctor if you are:

• Using any other prescribed medicines
• Using any recreational drugs, alcohol, herbal remedies, or over-the-counter medicines
• Using hormonal birth control, including the shot, pills, or implant. Some HIV medicines may affect how much of the hormone stays in your system, raising your risk for pregnancy. Talk to your doctor about the type of birth control you use and whether you need to switch to another method.
• Pregnant or planning to become pregnant. This will affect what treatment is best to keep you healthy and prevent HIV transmission to your baby.

HIV medicines also may cause different side effects in women than men.

• Studies linked the use of nevirapine (NVP) to a higher risk of rashes and problems with the liver for women with higher CD4 counts.
• Ritonavir (Norvir, RTV) may cause more nausea and vomiting in women but less diarrhea in women than in men. Ritonavir is sometimes prescribed to help other HIV medicines work better.
• Other studies show that women are more likely to get fat buildup throughout the body and have problems with the pancreas than men.

Do not change the dose of your medicine on your own. If you are having problems with side effects, talk to your doctor.

Read more about HIV/AIDS drugs and side effects for women at the Food and Drug Administration website.

Opportunistic infections (OIs) are infections that take advantage of weakness in the immune system. Most OIs that affect people with HIV are AIDS-defining OIs. This means that if you have HIV and develop one of these OIs, you now have advanced to AIDS, the final stage of HIV infection.

Eating healthy foods and preparing them safely is especially important for someone with HIV. Choosing healthy foods can help you keep a healthy weight and immune system. 

If you have problems like a sore mouth, diarrhea, nausea, or vomiting, or if treatment affects your sense of taste or your appetite, eating healthy might be tough. Talk to your doctor or nurse for help. He or she may recommend that you see a nutritionist.

Alcohol and drug use is common among people who have HIV or have a higher chance of getting HIV infection. Even if you already have HIV, using drugs puts you at risk of being infected with other strains of HIV or with other diseases. Drug and alcohol use can also interfere with your treatment:

• Your treatment might not work as well.
• You might have worse side effects.
• You might forget to take your medicine.
• Substance abuse also can lead to mental health problems or make them worse.

Talk to your doctor if you can't stop using drugs or alcohol. Your doctor can help you find a drug or alcohol treatment plan that will work with your HIV treatment. Find a treatment center near you.

Talk to your doctor before getting any vaccine. Discuss with your doctor which vaccines you need and are safe for you to get.

• Some vaccines, like the flu vaccine and the HPV vaccine, are more important to get if you have HIV. People who are infected with HIV should get the inactivated flu vaccine (the flu shot), not a live flu vaccine such as FluMist®.5 You need to prevent getting an infection your body can't fight. An infection could make your HIV worse.
• Other vaccines, such as the measles vaccine, may be more harmful if you have HIV and your immune system is not working well.
• There is no vaccine to prevent HIV.

Learn more about HIV and immunizations.

Thanks to treatment, many women with HIV are living longer lives. This also means that as women with HIV age, they will face health problems common in all older women. These problems include heart disease, diabetes, high blood pressure, arthritis, and some cancers.

Other health concerns as women with HIV age include:

Menopause. HIV affects women with menopause in unique ways.

• You may enter menopause at a younger age than normal (the average age in the United States is 52).6 The age of menopause in women with lower CD4 counts (fewer than 200 cells per cubic millimeter of blood) was four years younger than women whose CD4 count was more than 500 cells per cubic millimeter of blood. The age of menopause was also lower in women with CD4 counts between 200 cells and 500 cells per cubic millimeter of blood. The number of these white blood cells in a woman's blood tells doctors how serious her HIV infection is. Researchers think the drop in the female hormone estrogen after menopause may affect CD4 counts.
• Studies show that you may have more severe hot flashes during menopause than women who do not have HIV.

Osteoporosis — weakening of the bones — is a concern for all postmenopausal women but especially for women living with HIV. Recent studies show that osteoporosis may happen at younger ages in women (and men) who have HIV.9 Some HIV medicines may also lead to bone loss.

References

1. National Cancer Institute. (2011). HIV Infection and Cancer Risk.
2. AIDSinfo.gov. (2016). Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents.
3. World Health Organization. (2006). Sexual and reproductive health of women living with HIV/AIDS.
4. Department of Health and Human Services' Panel on Antiretroviral Guidelines for Adults and Adolescents. (2013). Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents.
5. Centers for Disease Control and Prevention. (2016). HIV/AIDS and the Flu.
6. Shifren, J.L., Gass, M.L.S., for the NAMS Recommendations for Clinical Care of Midlife Women Working Group. (2014). The North American Menopause Society Recommendations for Clinical Care of Midlife Women. Menopause; 21: 1038–1062.
7. Imai, K., Sutton, M.Y., Mdodo, R., del Rio, C. (2013). HIV and menopause: A systematic review of the effects of HIV infection on age at menopause and the effects of menopause on response to antiretroviral therapy. Obstetrics and Gynecology International: 340309. 
8. Wilder, T.L. (2013). Increased hot flash severity and burden among perimenopausal HIV-infected women: An interview with Sara Looby, Ph.D., ANP-BC. 
9. North American Menopause Society. (2013). Hot Flashes Take Heavier Toll on Women With HIV. Based on Menopause journal article.

Source

The Office on Women's Health in the U.S. Department of Health and Human Services

Content last updated January 30, 2019