Women Living with HIV
Women represent the fastest growing population of HIV/AIDS groups in the U.S. Women are diagnosed later than men because of the route of transmission, clinical manifestations, survival time, impact on reproductive health such as child bearing, gynecological disease and social factors.
Today, women make up nearly half of all the AIDS cases worldwide. In the last twenty years, the proportion of U.S. AIDS cases in women has more than tripled from 8% in 1985 to 27% in 2004 (CDC).
AIDS is the sixth leading cause of death in women 25 to 34 years of age in the U.S. and is the leading cause of death in African women in the same age group.
Most of the AIDS cases in adolescents are young women who are of African and Latin American decent. They are more likely to be infected through heterosexual intercourse.
Due to the prolonged incubation period from HIV infection to the time of an AIDS diagnosis it is probable that infection occurred during adolescents (CDC). Recent studies have shown that women with AIDS survive a shorter time than men when they are diagnosed later in the disease process. This may be due to poorer access to or use of the healthcare resources, homelessness, domestic violence, and lack of community support.
The most common cause of death in women was due to PCP, bacterial pneumonia, and toxoplasmosis. Women also demonstrated a higher incidence of candida infections, chronic or recurrent mucosocutaneous herpes and simplex infections. Men had a higher incidence of PCP and Kaposi's sarcoma.
HIV-positive women who are thinking about getting pregnant -- or already are pregnant -- have options that can help them stay healthy and protect their babies from becoming HIV-infected.
Since the mid-1990s, HIV testing and preventive measures have resulted in more than a 90% decline in the number of children in the U.S. infected with HIV in the womb. And after three decades of research, doctors now understand how to craft a detailed plan to keep babies of HIV-positive women from getting the virus.
One way of decreasing HIV in the newborn is to have the baby and mother tested prior to delivery. Naturally, the mother has to consent and the procedure must be explained to the mother at her level of understanding. If there is a chance that the baby will get HIV experts are now recommending several medications to reduce the newborn's chances of acquiring HIV. One is AZT and is given through the mother's vein. The other is a pill called Nevirapine. After the baby is born the doctor may place the newborn on AZT syrup. These medicines have been studied for use in pregnant women and newborns, and there have been no serious side effects.
Medications Are Key
HIV is passed from one person to another through blood, semen, genital fluids, and breast milk. Pregnancy, labor and delivery, and breastfeeding all pose a risk of passing HIV along to the baby.
Multiple studies have found that prevention starts with antiretroviral drugs. These medications were first approved in the 1990s, and researchers soon learned that combining three of them -- called an antiretroviral (ART) regimen -- added up to a lot of protection for a baby in the womb.
Starting women on well-tolerated antiretroviral medications as early as possible, can reduce the risk of transmission to less than 2%.
The drugs lower the amount of virus in the body, which lowers the risk of mother-to-child HIV transmission. Some anti-HIV medications also pass from the pregnant mother to her baby through the placenta. This helps protect the baby from HIV.
No Missed Doses
For all of this to work, the mom must commit to taking her ART regimen, which can sometimes be a challenge during pregnancy.
The key to keeping the virus suppressed in both the mother and baby is to make sure that she is taking her medications every day.
Preventive Meds for Baby – No Breastfeeding
During labor and delivery, when the baby may be exposed to HIV in the mother's genital fluids or blood, pregnant women infected with HIV get a steady intravenous drip of the antiretroviral drug AZT, while continuing to take their usual drugs by mouth.
Once they're born, babies get liquid AZT in a syrup for 6 weeks as a preventive measure. The babies whose moms didn't take anti-HIV meds during pregnancy may be given other anti-HIV medications along with AZT.
The final part of the care plan is to avoid breastfeeding, since breast milk is one of the primary body fluids through which HIV is passed.
The combination of viral suppression, not breastfeeding, and giving the baby liquid ART after birth are the keys to having an HIV-negative baby,
Mothers are encouraged to wait until the results of the confirmatory test are given before starting breastfeeding. The tragedy of HIV is that few women are aware of the risk and are not aware of their illness until their child becomes ill. The CDC has advocated universal counseling and testing for every pregnant woman regardless of geography, identified risk behavior, or self-identified risk. The pregnant patient may decline these services and the healthcare provider must document this has occurred.
