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Special Considerations in the Management of HIV in Women, Including During Conception and Pregnancy

Joseph J. Eron, Jr., MD
Program Director
Daniel R. Kuritzkes, MD
Program Director
Judith S. Currier, MD, MSc
Sigal Yawetz, MD
Released: May 21, 2020
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Introduction

Approximately 25% of all HIV/AIDS cases in the United States today are among women,[1,2] which is an increase from 7% in 1985.[3] Furthermore, approximately 30% of women with HIV are 50 years of age or older.[1,2] The predominant mode of HIV transmission among women continues to be through heterosexual intercourse.[4] Data suggest that although women tend to have more favorable clinical parameters at primary infection diagnosis when compared with men, subsequently women tend to have poorer clinical outcomes than men. This has been most prominent in nonwhite women and in women from the southern United States, who progress more rapidly than other groups.[5,6] Women with HIV face the same social stressors and life-altering events that all other women face. However, these events are further complicated by an underlying chronic medical illness that, without proper medical treatment, is fatal. With the widespread use of potent combination ART, women are now living longer with HIV. As a result, the vast majority of women with HIV will undergo normal life events, including pregnancy and menopause. Although women of childbearing potential continue to encompass the majority of women living with HIV, the number of older women with HIV increases each year. Tremendous progress has been made in addressing female-specific issues surrounding HIV care. Despite these efforts, however, many unanswered questions remain, and the HIV research and healthcare community must continue to strive to address sex-specific care-related questions so that management of women with HIV continues to improve. This module focuses on specific topics to consider in the clinical care of women with HIV in different life stages. In addition, a global overview of treatment-related issues and complications specific to women with HIV will be provided. For a more comprehensive overview of specific issues related to the clinical care of women with HIV, please refer to the DHHS guidelines.[7]

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