How Does AIDS Affect Women?

Most people newly infected with the HIV virus show few, if any, symptoms for a few years. But during this asymptomatic period, HIV is actively multiplying, infecting, and killing cells in the immune system, particularly CD4+ T cells. People are very infectious during this early phase.

As the immune system weakens, symptoms begin to emerge.

Early Symptoms Of HIV Infection

Some people, but not all, develop symptoms within a month or two of exposure to HIV. Men and women may have a flu-like illness with such symptoms as:

• Fever

• Rash

• Headache

• Loss of appetite

• Swollen glands (enlarged lymph nodes)

• Achy muscles and joints

These early symptoms usually disappear within a week to a month. Most HIV-infected people who experience these early symptoms won't see any more signs of the infection for at least a few years.

Later Symptoms Of HIV Infection

Usually, it takes about eight to nine years between the time of infection and the appearance of later symptoms, although this varies from person to person. These symptoms signal that immune system function is deteriorating, due to declining numbers of CD4+ T cells.

Not all people with HIV infection develop further symptoms. For those who do, however, symptoms may include:

• Persistent, enlarged lymph nodes

• Excessive fatigue

• Weight loss

• Frequent fevers

• Night sweats

• Chronic or frequent diarrhea

• Genital sores (sores around the penis or vagina)

• Thrush (an infection of the mouth caused by Candida, a yeast-like fungus) and mouth lesions

• Skin rash or flaky skin

• Joint stiffness and pain

• Bone pain

• Blurred vision

• Short-term memory loss

• Repeated bacterial, viral, or fungal infections

As the CD4+ T cell count continues to drop and the immune system deteriorates further, individuals may continue to experience the above symptoms as well as develop new ones.

There also are symptoms specific to women, such as gynecological problems.

What Symptoms Signal The Onset Of AIDS?

An HIV-infected person receives an AIDS diagnosis when he or she has:

• A CD4+ T cell count of less than 200, and/or

• At least one of more than two dozen opportunistic infections and conditions

In the United States, the most common AIDS-defining condition in both women and men is a lung infection called Pneumocystis carinii pneumonia, abbreviated PCP.

Other AIDS-defining conditions include severe body wasting and Candida infection of the esophagus, windpipe, or lungs.

What Symptoms Are Specific To Women?

Women and men are not equally susceptible to HIV- and AIDS-related conditions.

• For example, men are eight times more likely than women to get the skin cancer known as Kaposi's sarcoma.

• Some studies have shown that women with HIV infection are more likely than HIV-infected men to develop Candidiasis in the esophagus or active herpes simplex virus infections.

Gynecological problems occur more frequently and severely with HIV-infected women than in uninfected women. These problems include:

• Vaginal yeast infections

• Bacterial vaginosis (an imbalance of bacteria normally found in the vagina)

• Sexually transmitted diseases, including gonorrhea, chlamydia infection, and trichomoniasis

• Severe skin ulcers caused by herpes simplex virus

• Genital ulcers of unknown cause

• Human papillomavirus (HPV) infections, which can cause genital warts and can lead to cervical cancer

• Pelvic inflammatory disease that doesn't respond to treatment

• Menstrual irregularities

Unique Issues For Older Women

Women over age 45 should remind their doctors about age-appropriate health screening. Doctors can sometimes be so focused on treating and managing HIV that they forget to deliver age-appropriate health screening that includes monitoring for all the conditions noted above.

Depression is also a common issue among older women. While obvious psychological and social factors can increase rates of depression among positive older women (including fear of disclosure and loneliness), there may also be a physiologic basis for depression.

Here's why: After menopause, women produce less of the chemical serotonin. Low levels of this chemical are associated with depression, though this doesn't necessarily mean that low levels cause depression. Hormone-replacement therapy may lessen incidence of depression by raising serotonin levels. However, more studies are needed to determine if this is a direct benefit of hormone-replacement therapy.