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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the US and globally women are contracting the human immunodeficiency virus (HIV) and developing the acquired immunodeficiency syndrome (AIDS) the fastest. Worldwide, HIV is transmitted primarily through heterosexual intercourse. In the US, the proportion of women who have contracted AIDS by heterosexual transmission has increased from 11% in 1984 to 34% in 1990. Women are at a greater risk than men for transmission by heterosexual intercourse as the ratio of women to men who acquire AIDS by heterosexual transmission is 3 to 1. Furthermore, 25% of AIDS cases caused by heterosexual transmission or iv drug use occurs in women. Although women often develop HIV-related serious gynecologic problems, including cervical cancer and refractory vaginal candidiasis, these conditions do not fall within the Centers for Disease Control definition of AIDS. Women who have gynecologic symptoms are not diagnosed as having AIDS, are not eligible for AIDS benefits, and live half as long as men do once they are diagnosed as being HIV infected. Little is known about the characteristics of HIV infection or AIDS in women. Sexually transmitted diseases (STDs) seem to act as cofactors for HIV infection. The human papilloma virus or genital warts, the herpes simplex virus, syphilis, chancroid, recurrent vaginal candidiasis, abnormal Pap smears, cervical neoplasias, and pelvic inflammatory disease have been associated with HIV infection in women. HIV infection should be considered in all women with symptoms of any of these disorders. Nurses must first become aware of the clinical manifestations of HIV infection specific to women. Nursing interventions should educate about safer-sex including condom use with nonoxynol 9, and the risks of sharing needles. Strategies must be developed that provide empowerment skills and are sensitive to the women's cultural, religious, and ethnic background, beliefs, and values.
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PMID:Issues concerning women and AIDS: sexuality. 140 53

Both acquired immunodeficiency syndrome (AIDS) surveillance data and surveys on the seroprevalence of human immunodeficiency virus (HIV) indicate that HIV infection through heterosexual transmission is showing a trend of dramatic increase among US women. In women, especially pregnant women, AIDS has a more fulminant course than in men and there is a shorter survival time from diagnosis to death. Gynecologists may be the first source of medical contact among asymptomatic HIV-positive women, and primary care providers should aware of unusual gynecologic manifestations of HIV infection. Protracted herpes infection, refractory vaginal candidiasis, and widespread condylomata often represent early warning signs of an underlying immunocompromised state. Women with impaired cellular immunity are at greater risk of genital papillomavirus and neoplasia. Deficient cellular immunity also facilitates activation of latent infections such as cytomegalovirus, herpes simplex, and papillomavirus. Pelvic inflammatory disease is found in a disproportionately high number of HIV-infected women, although it is unknown whether the inflammation is secondary to the AIDS virus or a co-factor. Genital ulcers both increase the risk of HIV seroconversion and enhance the infectiousness of women already HIV-positive. Herpes simplex and other gynecologic conditions are likely to be more fulminant in presentation, more protracted in course, and resistant to conventional therapy in HIV-infected patients. To facilitate the early identification and treatment of these conditions, Pap smears should be taken every 4-6 months in infected women and there should be liberal use of colposcopy. Oral contraceptive users should be advised to switch to condom/nonoxynol-9 use to reduce the potential for disease transmission and accelerated progression.
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PMID:Primary care of women infected with the human immunodeficiency virus. 224 90

A 69-year-old woman sought treatment with a history of persistent debilitating intraoral ulcerations and recurrent oral and vaginal candidiasis. The medical history included thymoma, breast cancer, and lip cancer. The oral lesions were consistent with bullous lichen planus. Laboratory studies showed severe hypogammaglobulinemia. The chronic mucocutaneous candidiasis-thymoma syndrome is now recognized as a distinct form of primary immunodeficiency.
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PMID:Chronic mucocutaneous candidiasis-thymoma syndrome. A case report. 279 38

Twenty-four percent (7/29) of human immunodeficiency virus-infected women seen at Walter Reed Army Medical Center between 1983 and 1986 presented with a history of chronic refractory vaginal candidiasis. In addition to vaginal candidiasis, all patients were found to have oral thrush on physical examination, severe T-helper cell depletion (mean T-helper cell count of 90), and markedly decreased T4/T8 ratios (mean, 0.3); six of seven women were anergic by delayed-type hypersensitivity skin testing. The conditions of six (86%) of these seven women have progressed to acquired immunodeficiency syndrome (WR6 classification). Chronic refractory vaginal candidiasis may be a presenting symptom of human immunodeficiency virus infection. Women with human immunodeficiency virus infection and unexplained oral and vaginal candidiasis are at high risk to develop other opportunistic infections.
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PMID:Chronic vaginal candidiasis in women with human immunodeficiency virus infection. 349 72

Gynecologic disease is commonly encountered in women infected with the human immunodeficiency virus (HIV). The clinical course of cervical intraepithelial neoplasia, invasive cervical cancer, pelvic inflammatory disease, syphilis, and vaginal candidiasis may be altered by HIV infection and may be refractory to standard treatment, especially with increasing degrees of immune suppression. Careful screening for gynecologic disease and vigilant surveillance for treatment failure are important in the care of women infected with HIV.
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PMID:Gynecologic disease in women infected with human immunodeficiency virus type 1. 760 Jan 2

The most common spermicidal compound in use in North America is nonoxynol-9. Barrier methods of contraception used in combination with a spermicidal product help prevent a variety of sexually transmitted diseases. In 1991 the Centers for Disease Control reported a total of 620,478 cases of gonorrhea, 128,569 of syphilis, and 43,672 of acquired immunodeficiency syndrome (AIDS). The evidence for antimicrobial activity of spermicides against sexually transmitted disease pathogens has been accumulated during the last 20 years from in vitro and in vivo studies on Neisseria gonorrhea, Treponema pallidum, Chlamydia trachomatis, Trichomonas vaginalis, Herpes simplex viruses 1 and 2, and the human immunodeficiency virus. Uropathogenic bacteria, including E. coli, Proteus mirabilis, Enterococcus faecalis and Staphylococcus species, have been found to grow in concentrations of 25% or greater of nonoxynol-9. Less well known is the effect of nonoxynol-9 on the growth of lactobacilli, the predominant organisms colonizing the vagina of most healthy postpubertal and premenopausal women, which according to in vitro studies could inhibit the colonization and ascending infection of the bladder by E. coli and as E. faecalis. The organisms associated with bacterial vaginosis have been found to be inhibited by low concentrations of nonoxynol-9 (0.0019-0.5%). However, spermicide use does not appear to have any effect on the development of bacterial vaginosis. Clinical studies to date, with one exception, have shown no significant differences in bacterial vaginosis infection rates among users of diaphragms, contraceptive sponges and condoms and other contraceptive methods that do not involve exposure to spermicides. A history of nonoxynol-9 use as well as the use of antimicrobial agents should be considered in recurrent urogenital infections, since both can potentially disrupt the urogenital microbial flora. The physician must weigh the risk of exposure to sexually transmitted diseases or an unwanted pregnancy against the prevention of urinary tract infection or vaginal candidiasis before advising the patient to discontinue the use of nonoxynol-9-containing spermicides.
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PMID:The influence of nonoxynol-9-containing spermicides on urogenital infection. 805 30

Women are the fastest growing population with newly diagnosed acquired immune deficiency syndrome (AIDS) in the United States. Although little is known of specific female manifestations, research trends suggest an increase in genital tract infections and neoplasms that may be recurrent and difficult to treat. The initial presentation of early human immunodeficiency virus (HIV) infection in many women is recurrent and chronic vaginal candidiasis. Abnormal cervical cytology is common, and biannual Papanicolaou (Pap) smear screenings are recommended, preferably with a colposcopic examination. Because such human papillomavirus (HPV)-related dysplasias often are multifocal, anal Pap smears also are recommended. This article addresses the gynecologic problems and care of HIV-positive women.
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PMID:Gynecologic issues of women with human immunodeficiency virus infection. 824 48

Research into the biology of human immunodeficiency virus (HIV), and the immunopathogenesis of HIV disease, is proceeding rapidly. New therapies are being developed based on this new knowledge. Meanwhile, the proportion of women in the United States with AIDS is rising, and heterosexual spread is the fastest rising mode of transmission. Overall survival with HIV and AIDS appears to be similar in women and men receiving similar treatment. However, the results of several population-based studies indicate that women are less likely to have received antiretroviral therapy than have men. Gynecologic complications of HIV, including recurrent and refractory vaginal candidiasis and an increased frequency of cervical dysplasia and carcinoma, have only recently been recognized. There are still little data on the effect of pregnancy on the course of HIV disease in women. The implications of current knowledge for prevention and treatment of HIV in women are discussed.
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PMID:Human immunodeficiency virus and AIDS. 1993 update. 838 55

Mucosal candidiasis (oropharyngeal, esophageal, and vulvovaginal candidiasis) has been among the most prominent opportunistic infections in persons infected with human immunodeficiency virus (HIV). Esophageal candidiasis, an AIDS-defining illness, accounted for 15% of the AIDS-defining illnesses in adults and adolescents diagnosed in the United States through 1992. The diagnosis of oropharyngeal and vaginal candidiasis is based on clinically consistent signs and symptoms and a positive culture or a positive gram, KOH, or calcofluor stain, whereas the diagnosis of esophageal and pulmonary candidiasis is based on histopathology. Although a prospective controlled trial showed that prophylaxis with fluconazole can reduce the risk of mucosal candidiasis in patients with advanced HIV disease, routine primary prophylaxis is not recommended because of the effectiveness of therapy for acute disease, the low mortality associated with mucosal candidiasis, the potential for development of drug-resistant candidal infection, and the cost of prophylaxis. The probability of recurrences increases as CD4 counts decline. Nonetheless, many experts do not recommend chronic prophylaxis to prevent recurrent oropharyngeal and vulvovaginal candidiasis, for the same reasons that primary prophylaxis is not recommended. However, if recurrences are frequent or severe following documented esophageal candidiasis, long-term suppressive therapy with fluconazole should be considered.
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PMID:Opportunistic candidal infections in patients infected with human immunodeficiency virus: prevention issues and priorities. 854 20

Early in the AIDS epidemic, retrospective studies reported that vaginal candidiasis occurred more frequently in women who were infected with human immunodeficiency virus (HIV) than in those who were not infected. Some investigators suggested that new onset or recurrent vaginal candidiasis might identify HIV-infected individuals and predict the course of AIDS in women already known to be infected. In this article, studies of vaginal candidiasis in HIV-infected women are examined, and several observations are made. First, early studies were small and likely reflected biased populations. Second, adherence to previously accepted diagnostic criteria for vaginal candidiasis was not consistent in these studies. Finally, conclusions about the increased risk of recurrent or chronic candidal vaginitis in HIV-infected women have been promulgated in the medical literature and may have influenced clinical practice even though such statements are not supported epidemiologically. Prospective trials with uninfected community controls should determine the true impact of HIV infection on vulvovaginal candidiasis.
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PMID:Is vulvovaginal candidiasis an AIDS-related illness? 872 39


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