How Does HIV Affect Women Differently?

HIV may cause some health problems that are unique to women, such as:

• Gynecological health issues
• Increased risk of cervical cancer
• Increased risk of heart disease
• HIV medicine side effects and drug interactions
• Aging-related issues

Pregnancy and birth control also require careful management with a health care provider.

The good news is that women who take HIV medicine (called antiretroviral therapy or ART) daily as prescribed and get and keep an undetectable viral load can stay healthy and have effectively no risk of transmitting HIV to an HIV-negative partner through sex.

Gynecological Health Issues and HIV

Gynecological problems are common among women living with HIV. Some of the issues women may experience are:

• Problems related to sexually transmitted diseases (STDs)—Some STDS, like genital herpes, pelvic inflammatory disease (PID), and chancroid can happen more often and be more severe and/or harder to treat in women living with HIV than in HIV-negative women. STD screening and treatment is important for the health of a woman living with HIV and because having HIV and other STDs may increase the risk of HIV transmission to sexual partners.
• Vaginal yeast infections—In women living with HIV, vaginal yeast infections can occur more frequently and be harder to treat. Recurring vaginal yeast infections (those that happen at least four times a year) can happen more often in women with advanced HIV or AIDS.
• Bacterial vaginosis (BV)—BV is a condition caused by changes in the amount of certain types of bacteria found in the vagina. BV is more common in women living with HIV and may be harder to treat.
• Menstrual cycle problems—Women living with HIV may experience missed periods, lighter or heavier bleeding, or more severe premenstrual syndrome.

Treatment is available for these health conditions. Talk to your health care team about treatment options that are right for you.

Cervical Cancer and HIV

Women with HIV have a higher risk of cervical cancer. It is important that they be screened regularly for this disease.

Cervical cancer is cancer that starts in the cervix, the lower, narrow part of the uterus (the womb). It is almost always caused by human papillomavirus (HPV) infection.

The types of HPV that cause cervical cancer are more common in women with HIV. For this reason, women with HIV need to get regular Pap tests to help find changing cervical cells before they turn into cancer. Talk to your health care provider about the Pap test schedule that is right for you. In addition, the HPV vaccine is recommended for women (and men) with HIV infection through age 26.

Cervical cancer is an AIDS-defining cancer. That means that a diagnosis of cervical cancer marks the point at which a person’s HIV infection has progressed to AIDS.

HIV Medicine Side Effects and Drug Interactions

HIV medicine works as well for women as it does for men. However, some medicines can cause different side effects in women than men. For example:

• Nevirapine side effects—Studies have linked the HIV medicine nevirapine (also called Viramune or NVP) to a higher risk of rashes and liver problems for women with higher CD4 counts.
• Ritonavir side effects—The HIV medicine ritonavir (also called Norvir or RTV) may cause more nausea and vomiting in women. It is sometimes prescribed to help other HIV medicines work better.

HIV medicines can also put women at higher risk than men of getting fat buildup throughout their bodies or of having pancreas problems.

In addition, HIV medicines can interact with other drugs, which can harm you or make your HIV medicines less effective. These include:

• Prescribed medications
• Over-the-counter medicines
• Recreational drugs and alcohol
• Herbal remedies

If you are taking HIV medicines and have problems with any side effects or questions about drug interactions, talk to your health care provider or pharmacist to find solutions that work for you. Do NOT cut down on, skip, or stop taking your HIV medicines unless your provider tells you to.

Women’s Aging and HIV

Thanks to effective HIV treatment, women with HIV are living longer lives. That also means that as they age, they face the same health problems that many other older women do, such as 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—Women with HIV may enter menopause younger or have more severe hot flashes than women who do not have HIV. Researchers also think the drop in the female hormone estrogen after menopause may affect women’s CD4 counts.
• Osteoporosis—Osteoporosis is a disease that causes bones to become weak and easy to break. It is a concern for all older women, but especially for women with HIV. Bone loss occurs faster in women (and men) living with HIV than in people who do not have HIV. Some HIV medicines may also increase the risk of osteoporosis.

If you have questions about symptoms of the menopause or about osteoporosis, talk to your health care team. 

Heart Disease and HIV

HIV-related heart disease is a leading cause of death among people living with HIV—even when they are on consistent, effective HIV treatment. 

The risk of heart attack is especially a concern for women. 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 with HIV affect heart disease risk and what to do about it.