Caring for yourself as a woman with HIV means keeping an eye on more than just the virus. Liz Highleyman asks three top HIV doctors what exactly you should be looking for
Finding a good doctor and getting emotional support belong at the top of any HIV positive person’s to-do list—male or female. But some of the health issues are a little different. “A positive woman must pay as much attention to her reproductive-tract health as she does to her viral load and CD4 count,” advises Vicki Cargill-Swiren, MD, director of minority research and clinical studies at the National Institutes of Health’s Office of AIDS Research. These are the main women-only concerns:
HPV Women with HIV are more vulnerable than other women to the human papillomavirus, or HPV, which can cause everything from genital warts to dysplasia—abnormal cells in the cervix or anus that can develop into cancer. Pap smears (a swab of cells) are your best weapon against HPV—your doctor can assess the results. “Thanks to [Pap smears] and aggressive treatment, we have not seen increases in cervical cancer,” reports Susan Cu-Uvin, MD, of Brown University’s obstetrics and gynecology department.
Meg D. Newman, MD, at the University of California at San Francisco’s Positive Health Program, recommends that women with CD4 cell counts below 200 (your doctor will test your blood for this) get Pap smears every six months. If your count is higher and everything checks out OK on your first two to three Paps after testing positive, you can generally cut visits down to once a year.
Herpes & chlamydia While you’re down there, make sure you get checked for other STDs, too. Genital herpes outbreaks can be harder to treat in HIV positive women and can increase the chances of transmitting HIV to your sex partner or baby. And chlamydia—common in all women—can lead to big problems later on if not treated with antibiotics.
Yeast Infections Frequent yeast infections may be an early clue that a woman has HIV. But Dr. Newman says these aren’t any more common in positive women—just harder to treat. If you’ve got that itch, don’t ignore it. Talk to your doctor.
Med Side Effects Some studies suggest women have more—or different—side effects from certain HIV meds. Women taking nukes, for instance, seem more likely than men to develop lactic acidosis (a condition that can cause weakness and shortness of breath). And in some early studies on protease inhibitors (PIs), women were more likely to have nausea, while men experienced more diarrhea.
Another complaint: body-shape changes, like expanding breasts and bellies or shrinking cheeks and derrières—signs of lipodystrophy, or lipo, a side effect of some HIV meds. The jury is out on whether lipo happens differently in women and men and whether or not fat gain is caused as much by age as meds. But lipo’s thinning is definitely related to the meds you’re taking—and can be a big problem for women. “My ass is just gone. It’s like a deflated balloon,” says “Jill,” who has been on and off HIV treatment for 15 years. If your body seems to be changing quickly, let your doctor know. You may be able to switch to a more fat-friendly drug.
THE PILL VS. THE CONDOM The pill can interact with some HIV meds, risking accidental pregnancy or an increased risk of pill-related side effects—or your body might not get as much of your HIV drugs as it should. Alternative birth control methods include hormone patches and injected Depo-Provera. Dr. Newman prefers condoms above all, however, because women with HIV need to worry about getting reinfected with another strain of HIV, contracting other STDs and, of course, preventing transmission to their partner. “We always recommend a barrier method,” she says.