Nearly half of all HIV infections worldwide occur in women, and 20% of AIDS cases in the United States are women. Differences in HIV virologic and immunologic markers occur between men and women and have been studied to determine the effect on disease progression, mortality, and treatment. Certain adverse clinical events associated with highly active retroviral therapy (HAART), such as drug rashes and lipodystrophy, may affect women more than men. Depressive symptoms and low mental health quality of life occur commonly in HIV-infected women and can influence whether a woman will use HAART. Substance abuse among HIV-infected women is common, which can play a factor in coinfection rate with other infectious diseases and adherence to therapy. Also, HIV-infected women are at risk for increased severity and prevalence of human papillomavirus, which can be associated with cervical cancer. As demographics of HIV infection change, medical, psychological, and social problems must be addressed.
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References
1.
1. Centers for Disease Control and Prevention. Surveillance report HIV/AIDS. Available at: www.cdc.gov. Accessed December 2002.
2.
2. Atlman LK. Women catch up to men in global HIV cases. New York Times. November 27, 2002.
3.
3. Bush CE, Donovan RM, Markowitz N, Baxa D, Kvale P, Saravolatz LK. Gender is not a factor in serum human immuno-deficiency virus type 1 RNA levels in patients with viremia . J Clin Microbiol. 1996;34: 970-972 .
4.
4. Evans JS, Nims T, Cooley J, et al. Serum levels of virus burden in early-stage human immunodeficiency virus type 1 disease in women . J Infect Dis. 1997;175: 795-800 .
5.
5. Farzadegan H, Hoover DR, Astemborski J, et al. Sex differences in HIV-1 viral load and progression to AIDS . Lancet. 1998;352: 1510-1514 .
6.
6. Junghans C, Ledergerber B, Chan P, Weber R, Egger M. Sex differences in HIV-1 viral load and progression to AIDS . Lancet. 1999;353: 589 .
7.
7. Moroni M. Sex differences in HIV-1 viral load and progression to AIDS. ICONA Study Group. Italian cohort of HIV-1 positive individuals . Lancet. 1999;353: 589-590 .
8.
8. Moore RD, Cheever L, Keruly JC, Chaisson RE. Lack of sex difference in CD4 to HIV-1 RNA viral load ratio . Lancet. 1999;353: 464 .
9.
9. Kalish LA, Collier AC, Flanigan TP, Kumar PN. Plasma human immunodeficiency virus (HIV) type I RNA load in men and women with advanced HIV-1 disease . J Infect Dis. 2000;182: 603-606 .
10.
10. Sterling TR, Lyles CM, Vlahov D, Astemborksi J, Margolick JB, Quinn TC. Sex differences in longitudinal human immunodeficiency virus type 1 RNA levels among seroconverters . J Infect Dis. 1999;180: 666-672 .
11.
11. Sterling TR, Vlahov D, Astemborski J, Hoover DR, Margolick JB, Quinn TC. Initial plasma HIV-1 RNA levels and progression to AIDS in women and men . N Engl J Med. 2001;344: 720-725 .
12.
12. Prins M, Robertson JR, Brettle RP, et al. Do gender differences in CD4 cell counts matter? AIDS. 1999;13: 2361-2364 .
13.
13. Greenblatt RM, Ameli N, Grant RM, et al. Impact of the ovulatory cycle on virologic and immunologic markers in HIV-infected women . J Infect Dis. 2000;181: 82-90 .
14.
14. Morlat P, Parneix P, Lacoste D, et al. Women and HIV infection: a cohort study of 483 HIV-infected women in Bordeaux, France, 1985-1991. The Groupe d'epidemiologie Clinique du SIDA en Aquitaine . AIDS. 1992;6: 1187-1193 .
15.
15. Friedland G, Saltzman B, Vilano J, et al. Survival differences in patients with AIDS . J Acquir Immune Defic Syndr. 1991;4: 144-153 .
16.
16. Lemp GF, Hirozawa AM, Cohen JB, Derish PA, McKinney KC, Hernandez SR. Survival for women and men with AIDS . J Infect Dis. 1992;166: 74-79 .
17.
17. Melnick SL, Sherer R, Louis T, et al. Survival and disease progression according to gender of patients with HIV infection: the Terry Beirn Community Programs for Clinical Research on AIDS . JAMA. 1994;272: 1915-1921 .
18.
18. Moore RD, Hidalgo J, Sugland BW, Chaisson RE. Zidovudine and the natural history of the acquired immunodeficiency syndrome . N Engl J Med. 1991;324: 1412-1416 .
19.
19. Rothenberg R, Woelfel M, Stoneburner R, Milberg J, Parker R, Truman B. Survival with the acquired immunodeficiency syndrome: experience with 5833 cases in New York City . N Engl J Med. 1987;317: 1297-1302 .
20.
20. Chaisson RE, Keruly JC, Moore RD. Race, sex, drug use, and progression of human immunodeficiency virus disease . N Engl J Med. 1995;333: 751-756 .
21.
21. Centers for Disease Control and Prevention. 1993 revised classification system for HIV infections and expanded surveillance case definition for AIDS among adolescents and adults. MMWR1992;41: 1-19 .
22.
22. Cozzi Lepri A, Pezzotti P, Dorrucci M, Phillips AN, Rezza G. HIV disease progression in 854 women and men infected through injecting drug use and heterosexual sex and followed for up to nine years from seroconversion. Italian Seroconversion Study . BMJ. 1994;309: 1537-1542 .
23.
23. Anastos K, Kalish LA, Hessol N, et al. The relative value of CD4 cell count and quantitative HIV-1RNA in predicting survival in HIV-1 infected women: results of the women's interagency HIV study . AIDS. 1999;13: 1717-1726 .
24.
24. Egger M. Prognosis of HIV-1 infected drug naïve patients starting potent antiretroviral therapy: multicohort analysis of 12,040 patients . Presented at: 41st Annual Interscience Conference on Antimicrobial Agents and Chemotherapy; December 16-19, 2001; Chicago, Ill. Abstract LB-18.
25.
25. Hogg RS, Yip B, Chan KJ, et al. Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy . JAMA. 2001;286: 2568-2577 .
26.
26. Chen R, Westfall A, Cloud G, Chatham A, Acosta E, Raper J. Long-term survival after initiation of antiretroviral therapy . Presented at: 8th Conference on Retroviruses and Opportunistic Infections; February 4-8, 2001; Chicago, Ill. Abstract 341.
27.
27. Sterling TR, Bartlett JG, Moore RD. CD4+ lymphocyte level is better than HIV-1 plasma viral load in determining when to initiate HAART . Presented at: 8th Conference on Retroviruses and Opportunistic Infections; February 4-8, 2001; Chicago, Ill. Abstract 519.
28.
28. Panel on Clinical Practices for the Treatment of HIV. Guidelines for using antiretroviral agents among HIV-infected adults and adolescents: recommendations for the Panel on Clinical Practices for Treatment of HIV . MMWR. 2002;51: 1-55 .
29.
29. Yeni PG, Hammer SM, Carpenter CC, et al. Antiretrovial treatment for adult HIV infection in 2002: updated recommendations for the International AIDS Society-USA Panel . JAMA. 2002;288: 222-235 .
30.
30. Anastos K, Barron Y, Miotti P, et al. Risk of progression to AIDS and death in women infected with HIV-1 initiating highly active antiretroviral treatment at different stages of disease . Arch Int Med. 2002;162: 1973-1980 .
31.
31. Kauf TL, Gibbons DC, Kirkland TL, Capuano G, Tolson JM, Goodwin D. Modeling the impact of revised DHHS HIV treatment guidelines on survival in women . Presented at: 41st Annual Interscience Conference on Antimicrobial Agents and Chemotherapy; December 16-19, 2001; Chicago, Ill. Abstract 1913.
32.
32. Panel on Clinical Practices for Treatment of HIV Infection. Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents. Available at: http://www.aidsinfo.nih.gov/guidelines/archive.asp#50. February 2001.
33.
33. Moore AL, Mocroft A, Madge S, et al. Gender differences in virologic response to treatment in an HIV-positive population: a cohort study . J Acquir Immune Defic Syndr. 2001;26: 159-163 .
34.
34. Mocroft A, Gill MJ, Davidson W, Phillips AN. Are there gender differences in starting protease inhibitors, HAART, and disease progression despite equal access to care? J Acquir Immune Defic Syndr. 2000;24: 475-482 .
35.
35. Anderson KH, Mitchell JM. Differential access in the receipt of antiretroviral drugs for the treatment of AIDS and its implications for survival . Arch Int Med. 2000;160: 3114-3120 .
36.
36. Hellinger FJ. The use of health services by women with HIV-infection . Health Serv Res. 1993;28: 543-561 .
37.
37. Turner BJ, Markson LE, McKee LJ, Houchens R, Fanning T. Health care delivery, zidovudine use and survival of women and men with AIDS . J Acquir Immune Defic Syndr. 1991;7: 1250-1262 .
38.
38. Smith SR, Kirking DM. Access and use of medications in HIV disease . Health Serv Res. 1999;34(suppl 1, pt 1): 123-144 .
39.
39. Stein MD, Crystal S, Cunningham WE, et al. Delays in seeking HIV care due to competing caregiver responsibilities . Am J Pub Health. 2000;90: 1138-1140 .
40.
40. Panel on Clinical Practices for Treatment of HIV Infection. Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents. February 4, 2002. Updates available at: http://aidsinfo.nih.gov. Accessed January 29, 2003.
41.
41. John M, Moore C, James IR, Nolan D, Upton RP, McKinnon EJ, Mallal SA. Chronic hyperlactatemia in HIV-infected patients taking antiretroviral therapy . AIDS. 2001;15(6): 717-723 .
42.
42. Harris M, Tesiorowski A, Chan K, et al. Lactic acidosis complicating antiretroviral therapy: frequency and correlates . Antiviral Therapy. 2000;5(suppl 2): 31 .
43.
43. Fortgang IS, Belitsos PC, Chaisson RE, Moore RD. Hepatomegaly and steatosis in HIV-infected patients receiving nucleoside analog antiretroviral therapy . Am J Gastroenterol. 1995;90(9): 1433-1436 .
44.
44. Boubaker K, Sudre P, Flepp M, Furrer A, Haensel B, Hirschel K, et al. Hyperlactatemia and antiretroviral therapy in the Swiss HIV Cohort Study . 7th Conference on Retroviruses and Opportunistic Infections; January 30-February 2, 2000; San Francisco, Calf. Abstract 57.
45.
45. Boxwell DE, Styrt BA. Lactic acidosis in patients receiving nucleoside reverse transcriptase inhibitors . 39th Interscience Conference on Antimicrobial Agents and Chemotherapy; September 26-29, 1999; San Francisco, CA. Abstract 1284.
46.
46. Ter Hofstede HJM, de Marie S, Foudraine NA, Danner SA, Brinkman K. Clinical features and risk factors of lactic acidosis following long-term antiretroviral therapy: 4 fatal cases . Int J STD AIDS. 2000;11(9): 611-616 .
47.
47. Luzzati R, Del Bravo P, Di Perri G, Luzzani A, Concia E. Riboflavin and severe lactic acidosis [letter] . Lancet. 1999;353(9156): 901-902 .
48.
48. Bristol Myers Squibb Company. Important drug warning [letter to healthcare providers]. January 5, 2001.
49.
49. Kakuda TN. Pharmacology of nucleoside and nucleotide reverse transcriptase inhibitor-induced mitochondrial toxicity . Clin Ther. 2000;22(6): 685-708 .
51. Miller KD, Cameron M, Wood LV, Dalakas MC, Kovacs JA. Lactic acidosis and hepatic steatosis associated with use of stavudine: report of four cases . Ann Intern Med. 2000;133(3): 192-196 .
52.
52. Mokrzycki MH, Harris C, May H, Laut J, Palmisano J. Lactic acidosis associated with stavudine administration: a report of five cases . Clin Infect Dis. 2000;30(1): 198-200 .
53.
53. Martinez E, Bianco JL, Arnaiz JA, et al. Hepatotoxicity in HIV-1 infected patients receiving nevirapine-containing antiretroviral therapy . AIDS. 2001;15(10): 1261-1268 .
54.
54. Barlett J. Severe liver toxicity in patients receiving two nucleoside analogues and a non-nucleoside reverse transcriptase inhibitor . In: Program and abstracts of the 8th Conference on Retroviruses and Opportunistic Infections; February 4-8, 2001; Chicago, Ill. Abstract 19.
55.
55. Boehringer-Ingelheim/Roxane Laboratories. Important drug warning. Re: severe, life-threatening and fatal cases of hepatotoxicity with VIRAMUNE [letter]. November 2000.
56.
56. Mazhude C, Jones S, Shahed M, Taylor C, Easterbrook P. Female sex but not ethnicity is a strong predictor of non-nucleoside reverse transcriptase inhibitor-induced rash . AIDS. 2002;16: 1566-1568 .
57.
57. Dong KL, Bausserman L, Flynn M, et al. Changes in body habitus and serum lipid abnormalities in HIV-positive women on highly active antitretoviral therapy . J Acquir Immune Defic Syndr. 1999;21: 107-113 .
58.
58. Mahajan AP, Tashima KT, Bausserman LL, Flynn MM, Carpenter C. Plateau in body habitus changes and serum lipid abnormalities in HIV-positive women on highly active antiretroviral therapy: a 3.5-year study . J Acquir Immune Defic Syndr. 2001;28: 332-335 .
59.
59. Cook JA, Cohen MH, Burke J, et al. Effects of depressive symptoms and mental health quality of life on use of highly active antiretroviral therapy among HIV-seropositive women . J Acquir Immune Defic Syndr. 2002;30: 401-409 .
60.
60. Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population . Applied Psychological Measurement. 1977;1: 385-401 .
62. Centers for Disease Control and Prevention. HIV/AIDS surveillance report. 2002;13.
63.
63. Spittal PM, Craib KJP, Wood E, et al. Risk factors for elevated HIV incidence rates among female injection drug users in Vancouver . CMAJ-JAMC. 2002;166(7): 894-899 .
64.
64. Hsu JH. Substance abuse and HIV . Hopkins HIV Report. 2002; 14(4): 8-12 .
65.
65. Selwyn PA, Alcabes P, Hartel D, et al. Clinical manifestations and predictors of disease progression in drug users with human immunodeficiency virus infection . N Eng J of Med. 1992;24: 1697-1703 .
66.
66. Webber MP, Schoenbaum EE, Gourevitch MN, Buono D, Klein RS. A prospective study of HIV disease progression in female and male drug users . AIDS. 1999;13(2): 257-262 .
67.
67. O'Connor PG, Selwyn PA, Schottenfeld RS. Medical progress: medical care for injection-drug users with human immunodeficiency virus infection . N Eng J Med. 1994;331: 450-459 .
68.
68. Barnes PF, Yang Z, Preston-Martin S, et al. Patterns of tuberculosis transmission in Central Los Angeles . JAMA. 1997;278: 1159-1163 .
69.
69. Koo DT, Baron RC, Rutherford GW. Transmission of mycobacterium tuberculosis in a California State Prison, 1991 . Am J Public Health. 1997;87: 279-282 .
70.
70. Centers for Disease Control and Prevention. Epidemiologic notes and reports of crack cocaine use among persons with tuberculosis: Contra Costa County, California, 1987-1990 . MMWR. 1991;40: 485-489 .
71.
71. Leonhardt KK, Gentile F, Gilbert BP, Aiken M. A cluster of tuberculosis among crack house contacts in San Mateo County, California . Am J Public Health. 1994;84: 1834-1836 .
72.
72. Arici C, Ripamonti D, Maggiolo F, et al. Factors associated with failure of HIV-positive persons to return for scheduled medical visits . HIV Clin Trials. 2002;3(1): 52-57 .
73.
73. Lucas GM, Kelly AG, Chaisson RE, Moore RD. AIDS. 2002;16(5): 767-774 .
74.
74. Gourevitch MN. Interactions between HIV-related medications and methadone: an overview . Mt Sinai J Med. 2000;67: 429 .
75.
75. Cohn JA. HIV-1 infection in injection drug users . Inf Dis Clinics of NA. 2002;16(3): 745-770 .
76.
76. Wright TC, Ellerbrock TV, Chiasson MA, Van Devanter N, Sun XW, and the New York Cervical Disease Study. Cervical intraepithelial neoplasia in women infected with human immunodeficiency virus: prevalence, risk factors, and validity of Papanicolaou smears . Obstet Gynecol. 1994;84: 591-597 .
77.
77. Mandelblatt JS, Kanetsky P, Eggert L, Gold K. Is HIV infection a cofactor for cervical squamous cell neoplasia? Cancer Epidem Biomarker Prev. 1999;8: 97-106 .
78.
78. Massad LS, Riester KA, Anastos KM, et al. Prevalence and predictors of squamous cell abnormalities in Papanicolaou smears from women infected with HIV-1 . J Acquir Immune Defic Syndr. 1999;21: 33-41 .
79.
79. Six C, Heard I, Bergeron C, et al. Comparative prevalence, incidence and short-term prognosis of cervical squamous intraepithelial lesions amongst HIV-positive and HIV-negative women . AIDS. 1998;12: 1047-1056 .
80.
80. Frisch M, Biggar IJ, Goedart JJ. Human papillomavirus-associated cancers in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome . J Natl Cancer Inst. 2000;92: 1500-1510 .
81.
81. Li TS, Tubiana R, Katlama C, Calfez V, Ait Mohand H, Autran B. Long-lasting recovery in CD4 T-cell function and viral-load reduction after highly active antiretroviral therapy in advanced HIV-1 disease . Lancet. 1998;351: 1682-1686 .
82.
82. Heard L, Schmitz V, Costagliola D, Orth G, Kazatchkinem MD. Early regression of cervical lesions in HIV-seropositive women receiving highly active antiretroviral therapy . AIDS. 1998;12: 1459-1464 .
83.
83. Heard I, Tassie JM, Kazatchkinem MD, Orth G. Highly active antiretroviral therapy enhances regression of cervical intraepithelial neoplasia HIV-seropositive . AIDS. 2002; 16(13): 1799-1802 .
84.
84. Minkoff J, Ahdieh L, Massad LS, et al. The effect of highly active antiretroviral therapy on cervical cytologic changes associated with HPV in HIV-infected women . AIDS. 2001;15: 2157-2164 .
85.
85. Robinson WR, Hamilton CA, Michaels SH, Kissingter P. Effect of excisional therapy and highly active antiretroviral therapy on cervical intraepithelial neoplasia in women infected with human immunodeficiency virus . Am J Obst Gynecol. 2001;184: 538-543 .
86.
86. Jamison DJ, Duerr A, Burk R, et al. Characterization of genital human papillomavirus infection in women who have or who are at risk of having HIV infection . Am J Obstet Gynecol. 2002;186(1): 21-27 .
87.
87. Kulasingam SL, Hughes JP, Kiviat NB, et al. Evaluation of human papillomavirus testing in primary screening for cervical abnormalities . JAMA. 2002;288(14): 1749-1757 .
88.
88. Koutsky LA, Ault KA, Wheeler CM, et al. A controlled trial of a human papillomavirus type 16 vaccine . N Engl J Med. 2002; 347(21): 1645-1651 .
