HIV Infection in Women

Abstract

Human immunodeficiency virus (HIV) infection is caused by an RNA retrovirus that is trophic for CD₄ lymphocytes. By attacking and ultimately destroying these cells, the virus causes a severe deficiency in cell-mediated immunity, rendering the host susceptible to a myriad of opportunistic infections and malignancies. HIV infection occurs in a continuum, ranging from the initial, acute retroviral illness to florid acquired immunodeficiency syndrome (AIDS). At the present time, more than 500,000 Americans have been afflicted with AIDS. More than one million Americans are in pre-AIDS stages of their illness. In the United States, 15 to 20% of patients with HIV infection are women. Among women, the two most important risk factors for infection are IV drug use and heterosexual contact with a high-risk male. Factors that increase the risk of sexual transmission of HIV infection include multiple partners, receptive anal intercourse, concurrent use of IV drugs or crack cocaine, other STDs, intercourse during menses or in the presence of ulcerative genital lesions, and contact with an uncircumcised male. More than 90% of all cases of HIV infection in children result from direct perinatal transmission from an infected mother. Transplacental dissemination and intrapartum transmission are the two most important mechanisms of perinatal infection. HIV infection can also be transmitted by breastfeeding and by close personal contact following delivery. The risk of vertical transmission can be reduced significantly by treating HIV-infected patients and their neonates with antiviral chemotherapy. Because HIV infection is such a severe, and usually, fatal illness, great emphasis should be placed on preventive measures. Mental health professionals can play a pivotal role in the management of HIV-infected patients, particularly in helping them cope with the terminal stages of their illness.