How Does HIV Affect Women?
HIV affects women’s bodies in unique ways. If you are a woman living with HIV, you may experience changes in your menstrual cycle or get different side effects from HIV medicines than men. HIV can also cause other health problems that are unique to women. But by taking care of your health, taking HIV medicine (called antiretroviral therapy or ART), and staying in regular medical care, you can keep the virus under control and live a long, healthy life.
Below is some information about health issues that women living with HIV may experience.
HIV and Sexually Transmitted Infections (STIs)
- Genital herpes. Genital herpes is an STI caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2). 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 treatment may not work as well as in women with HIV, who may develop resistance to the herpes medicine. Learn more about genital herpes.
- Chancroid. Chancroid (SHAN-kroid) is an STI caused by a bacterium. Very few people are diagnosed in the United States each year with this infection. 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 living with HIV, chancroid ulcers may heal more slowly or may need to be treated more than once. Learn more about chanchroid.
- Pelvic inflammatory disease (PID). PID is an infection of a woman's pelvic organs (uterus, fallopian tubes, and ovaries). In women living with HIV, PID may be harder to treat, may not go away, or may come back repeatedly as a woman's immune system weakens. PID also can make it harder to get pregnant. Learn more about PID.
HIV and Cervical Cancer
Cervical cancer is cancer that starts in the cervix, the lower, narrow part of the uterus (the womb). Cervical cancer is an AIDS-defining cancer. That means that a diagnosis of cervical cancer marks the point at which HIV infection has progressed to AIDS. Cervical cancer is almost always caused by human papillomavirus (HPV) infection. The types of HPV that cause cervical cancer are more common in women who are HIV-positive. For this reason, women with HIV need to get regular Pap tests to help find changing cervical cells before they turn into cancer.
All women living with HIV should get an initial Pap test at the time of the HIV diagnosis and a second Pap test (or a Pap and HPV co-test if you are older than 30) 12 months later. Some experts recommend a second Pap test or Pap and HPV co-test 6 months later, so talk to your doctor or nurse. After three normal Pap tests in a row, women living with HIV can get follow-up Pap tests every 3 years. Co-testing (Pap test and HPV test) is not recommended for women with HIV infection <30 years of age.
HIV and Vaginal Infections
Vaginal yeast infections are infections of the vagina that cause itching and burning of the vulva. Vaginal yeast infections are common and easily treated in most women, but can happen more often and may be harder to treat in women living with HIV. Recurring vaginal yeast infections (at least four times a year) happen more often in women with advanced HIV or AIDS. Learn more about vaginal yeast infections.
Bacterial vaginosis (BV) is a vaginal infection caused by changes in the amount or balance of bacteria normally found in the vagina. BV is more common in women living with HIV and may be harder to treat.Learn more about bacterial vaginosis.
HIV and the Menstrual Cycle
Women with HIV may have more menstrual problems than other women. If you are a woman living with HIV, 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 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. Learn more about menstrual cycle problems.
HIV and Heart Disease
People living with HIV, and especially women, face a greater risk of having a heart attack than people without HIV. Women living with HIV are three times more likely to have a heart attack than women without HIV. Research is underway to learn how factors unique to women affect heart disease risk and what to do about it.
HIV Treatment and Women
If you are living with HIV, it is important to take HIV medicines (called antiretroviral therapy or ART) every day, exactly as prescribed by your doctor or nurse, to get the virus under control and stay healthy. There is also an important prevention benefit: people with HIV who take HIV medicines daily prescribed, and get and keep an undetectable viral load have effectively no risk of passing HIV to their partners who do not have HIV.
However, some other drugs can interact with HIV medicines. These drug interactions can hurt you or make your 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 implants. Some HIV medicines may affect how much of the birth control 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. For example:
- Nevirapine. Studies linked the use of nevirapine (also called NVP, Viramune) to a higher risk of rashes and problems with the liver for women with higher CD4 counts.
- Ritonavir. Ritonavir (also called 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 HIV medicine on your own. If you are having problems with side effects, talk to your doctor. Read more about HIV medicine and side effects.
Pregnancy and HIV
Some women living with HIV wonder if they can have healthy pregnancies. The answer is yes! A diagnosis of HIV does not mean you can't have children. But you can pass HIV to your baby during the pregnancy, while in labor, while giving birth, or by breastfeeding. The good news is that there are ways to lower the risk of passing HIV to your unborn baby to 1% or less.
Learn about pregnancy and childbirth for women living with HIV.
HIV and Birth Control
Women with HIV can safely use any form of birth control to prevent pregnancy. But, as noted above, some HIV medicines can make hormonal birth control less effective. Talk to your health care provider about which form of birth control is right for you.
And be aware: women living with HIV should also use condoms every time they have sex to protect against STIs such as gonorrhea and syphilis.
HIV and Healthy Aging
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 that are common in all older women. These problems include heart disease, diabetes, high blood pressure, arthritis, and some cancers.
Women with HIV also may face also other health concerns as they age. These include:
- Menopause. HIV affects women with menopause in unique ways. For example, you may enter menopause at a younger age than normal (the average age in the United States is 52). Researchers also think the drop in the female hormone estrogen after menopause may affect CD4 counts. In addition, you may have more severe hot flashes during menopause than women who do not have HIV. Learn more about menopause.
- Osteoporosis. Osteoporosis is a disease of the bones. People with osteoporosis have bones that are weak and break easily. Osteoporosis is a concern for all postmenopausal women, but especially for women living with HIV. Osteoporosis may happen at younger ages in women (and men) who have HIV. Some HIV medicines may also increase the risk of osteoporosis. Learn more about HIV and osteoporosis.
This information was excerpted from the U.S. Department of Health and Human Services’ Office on Women’s Health. For more information, visit their page, HIV and Women’s Health.