A study has found that HIV-positive women often receive inadequate gynaecological care.
This study wasn’t conducted in a country with limited medical resources, but in Switzerland, one of the world’s richest countries – a country that has some of the world’s best healthcare facilities and where HIV treatment and care is freely available.
Women who were obese, smoked, used drugs or were poorly educated were less likely to receive regular examinations than other women. Given that proper gynaecological care is recommended for all HIV-positive women, I was shocked to read why the study’s authors believed these women received poorer care. For example, they suggested that doctors might be “uncomfortable” performing examinations on obese women. They added that poorly educated women might not know that they needed regular gynaecological care, or that women who smoked or used drugs might not really care about their health and therefore didn’t ask for a screen.
Let’s get something straight here. HIV treatment and care guidelines state that HIV-positive women should receive regular gynaecological care. So doctors really need to get over their discomfort or embarrassment about examining over-weight women, and surely, it isn’t the responsibility of women who are the most vulnerable and in the greatest need to tell their doctors what care guidelines say they need!
Gynaecological care for HIV-positive women
There is no difference in the way that HIV affects the immune systems of men and women, and anti-HIV therapy works equally well in men and women.
But HIV-positive women require special gynaecological care. This is particularly the case because women with HIV often have cervical infection with human papilloma virus (HPV), the virus that causes genital and anal warts, and some strains of this virus involve a high risk of cervical or anal cancer.
It is recommended in HIV treatment and care guidelines, such as those of the British HIV Association, that at all HIV-positive women should have a cervical PAP smear soon after their diagnosis with HIV and at yearly intervals thereafter. PAP smears are performed to see if there are any cancerous or pre-cancerous cells in the cervix. If detected early, cervical cancer can be treated effectively.
But a recent study conducted in Switzerland has found that 7% of HIV-positive women never had a gynaecological examination as part of their HIV care, and that a further 57% of women had examinations at irregular intervals.
Women who were of non-white ethnicity, as well as those who were poorly educated, under weight or obese, used drugs, or smoked were least likely to receive proper gynaecological care.
Anti-HIV therapy
There is no cure for HIV, but anti-HIV therapy can suppress viral load in the blood to very low levels, meaning that the immune system, measured by the number of key CD4 cells, is able to protect the body from certain infections and cancers.
HIV treatment guidelines, such as those of the British HIV Association, recommend that HIV therapy should include at least three anti-HIV drugs from two of the three main classes of antiretrovirals (nucleoside/nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, and protease inhibitors). The reason why HIV treatment consists of so many drugs is because HIV can quite easily become resistant to the drugs used to treat it. Taking a powerful combination can delay this happening, hopefully indefinitely.
But combinations of HIV drugs can be difficult to take properly, can cause side-effects; and, involve considerable cost.
Some of the anti-HIV drugs that have become available in recent years are much more powerful than those which were available before, and doctors have been particularly interested to see if treatment with a ritonavir-boosted protease inhibitor by itself is a safe and effective treatment for HIV. A lot of research has focused on the use of Kaletra in this way.
A new study involving a small number of Spanish patients shows that taking Kaletra by itself (monotherapy) is just as effective at suppressing viral load to extremely low levels (as little as 3 copies/ml) as traditional three-drug treatment. It is important to note that none of the people in the study had taken anti-HIV treatment before and did not have resistance to any anti-HIV drugs. Three-drug treatment for provided to all the patients in the study to start with and once viral load fell to undetectable levels they were randomised to either continue with their triple-drug treatment or to switch to Kaletra monotherapy.
Although the researchers were encouraged by their findings, they do not recommend Kaletra monotherapy as a universal strategy for treating HIV. Rather they suggest that there needs to be “careful identification of appropriate patients.”
Side-effects
Although anti-HIV therapy can mean a longer, healthier life, it can also cause side-effects. Side-effects can occur in both the short and longer-term. Some long-term side-effects, such as increased cholesterol, can mean that there is also a risk of developing other health problems, for example heart disease.
Side-effects are at very least unpleasant (and some can even be dangerous), and are one of the main reasons why people change their HIV treatment. They should always be taken seriously and if you develop a health problem after starting a new drug it is really important that you tell your HIV doctor, even if it seems minor, for example a headache or rash.