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Gynecologic Care for Women With Human Immunodeficiency Virus - pdf attached
 
 
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VOL. 116, NO. 6, DECEMBER 2010 OBSTETRICS & GYNECOLOGY
 
CLINICAL MANAGEMENT GUIDELINES FOR OBSTETRICIAN-GYNECOLOGISTS
 
The increased use of screening tests has led to the identification of large numbers of women with human immunode- ficiency virus (HIV). Consequently, there is an increased role for obstetrician-gynecologists in caring for infected women. Women infected with HIV are living longer, healthier lives and, therefore, the need for rotuine gynecologic care has increased. The purpose of this document is to educate clinicians about routine HIV screening practices as well as basic women's health screening and care, family planning, and preconception care for women who are infected with HIV.
 
Background
 
Basic Epidemiology and Prevalence

 
In the United States, women account for a growing proportion of patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) (from 7% in 1985 to 27% in 2007) (1). Hetero- sexual contact is responsible for 72% of HIV transmis- sion among women in the United States, and women of color are disproportionately affected, accounting for 80% of HIV-infected women (1, 2). In most women with HIV, the infection is diagnosed during their reproductive years (1).
 
Summary of Recommendations and Conclusions
 
The following recommendation is based on good and consistent scientific evidence (Level A):

 
Condoms are recommended for the prevention of HIV transmission as well as other STIs.
 
The following recommendations and conclusions are based on limited or inconsistent scientific evidence (Level B):
 
- The American College of Obstetricians and Gyne- cologists recommends routine HIV screening of women aged 19-64 years and targeted screening for women with risk factors outside of that age range.
 
- If counseling and written consent are not required, the patient should be notified that testing will be per- formed unless the patient declines (opt-out screening).
 
- Human papillomavirus testing currently has no role in the triage of HIV-infected women with abnormal cytology results or for follow-up after treatment for CIN.
 
- For women at high risk of HIV acquisition, HIV- infected women, HIV-infected IUD users converting to an AIDS diagnosis, and women with AIDS who are clinically well while taking HAART, the copper and levonorgestrel-containing IUDs may be used.
 
- Women with HIV infection should have cervical cytology screening twice in the first year after diag- nosis of HIV and annually thereafter.
 
- Routine colposcopy is recommended for HIV-infected women with ASC-US or higher grade abnormality.
 
The following recommendations are based primar- ily on consensus and expert opinion (Level C):
 
- Patients should be counseled that dual contraception (ie, the concomitant use of condoms and additional contraception) is the optimal contraceptive strategy to reduce heterosexual transmission of HIV and other STIs as well as minimizing the risk of unin- tended pregnancy.
 
- For women taking certain HAART regimens, com- bined OCs generally are not recommended because of potential alterations in the hormonal contraceptive and the antiretroviral drug as outlined in Box 2.
 
- Reproductive plans, including preconception coun- seling and counseling regarding reversible methods of contraception, if appropriate, should be discussed with HIV-infected women of childbearing age.
 
- Repeat cytologic testing at 6 months and 12 months is recommended for HIV-infected women with mild cytologic abnormalities, satisfactory colposcopy results, and no evidence of histologic high-grade disease.
 
- Couples where both partners are HIV infected should be counseled that condoms should be used to decrease the potential risk of superinfection.
 
 
 
 
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