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hrsa

participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



NEWS AND NEW DEVELOPMENTS



Evaluation and Management of HIV-Infected Women [Levine AM. Ann Intern Med 2002;136:228] The author reviews HIV infection in women. The following is a summary that highlights those issues specific to women:
Common gynecologic infections

  • Candida vaginitis: More common, seen at relatively high CD4 counts; not more severe, but more persistent and less responsive to therapy [Medicine 1991;70:307]
  • HPV: More frequent (28 vs. 64%) [CID 1999;29:1145]
  • Bacterial vaginosis: No more frequent with HIV [CID 1999;29:1145]
  • PID: CDC recommendation is for parenteral antibiotics more frequently [MMWR 1998;47:1]

Indications for antiretroviral drugs

  • HIV RNA levels are lower [NEJM 2001;344:720] and CD4 counts may be higher [AIDS 199;13:2361] in women than in men for same prognosis. It is possible that different thresholds should be used for initiating therapy

Pelvic exam

  • PAP smears: More frequently abnormal (40% vs. 17%) [JAIDS 1999;21:33]; this correlates with lower CD4 counts and higher risk of cervical cancer [Am J Ob Gyn 1999;164:593]
  • Cervical cancer: Increased HPV rate correlates with decreased CD4 count [Ob Gyn 1992;79:321] there is more persistence and more cervical cancer [NEJM 1999;341:1633] Prognosis: Similar to that of men [NEJM 1995;333:751]

posted 2/20/2002





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