Signs and Symptoms of HIV in Women

Women account for 1 in every 5 new cases of HIV each year. While most of these cases are as a result of unprotected sexual activity, about 20% of the cases are as a result of illicit drug use (sharing needles). Sadly, about 10% of women infected with HIV are unaware of their status, making it more likely for infection rates to increase.

The symptoms for HIV is similar for both men and women, however, there are some signs and symptoms that are specific to women alone and usually occur in either the early or later stages of infection. To find out more about HIV and its specific symptoms for men or women, visit your nearest sexual health clinic.

Acute HIV infection

This is also known as acute seroconversion and is the first of the three stages of HIV immediately after exposure to the virus. During this first stage, defensive antibodies are produced by the immune system to help in the fight against the virus and subdue the infection.  The acute seroconversion phase lasts for 7 to 14 days, and during this phase, people who are infected may begin to experience symptoms that are referred to as acute retroviral symptoms or ARS. These symptoms are just like the flu symptoms and can include mild fever, body ache, rash and swollen lymph nodes.

Disparities in infection rates

Although the acute symptoms in both men and women are generally the same, the variation is in seroconversion rate. Women who are heterosexual are twice more likely to get infected per sexual act as compared to men who are heterosexual. This is partly due to the increased size and porosity of the vaginal tissues as compared to that of the penis.

This does not only confer to the higher rate of infection among women but also in the faster progression of the disease. According to a journal reviewed in 2014, women with HIV have a 1.6 fold greater risk of progressing to AIDS than men.

HIV and STD co-infection

If there is an accompanying STD infection in addition to the HIV infection, the symptoms of such STD infection will begin to manifest during the acute seroconversion phase. Although studies have suggested that about 1 in 7 people who are infected with HIV are co-infected with a type of STD as at the time of diagnosis, this situation is not entirely uncommon.

In the cases of women with HIV, the most common STDs that accompany it include Chlamydia, gonorrhoea, syphilis and trichomoniasis. Besides being co-infected, having any of these STDs or non-sexually transmitted ones like bacterial vaginosis can increase the chances of a woman getting HIV by 2 or 3 fold. The thing to note is that having these infections will not only undermine the barrier function but will also increase the concentration of immune cells at the site of the infection, which is the cervix. Some of the concentration of immune cells are CD4 T-cells, which are the very cells that are targeted and infected by HIV.

In the case of co-infection, HIV can be identified, not by its own symptoms but by the signs and symptoms of the STD.

Symptoms	Chlamydia	Syphilis	Gonorrhoea	Trichomoniasis
Vaginal discharge	X		X	X
Bleeding between periods (metrorrhagia)	X		X
Strong, fish-like odour				X
Vaginal itchiness (pruritus)				X
Painless vaginal sore (chancre)		X
Pain with sex (dyspareunia)	X		X
Burning sensation with urination (dysuria)	X		X	X

For this reason, anyone who seeks diagnosis and treatment of STD should also get tested for HIV as recommended by the CDC.

Chronic HIV infection

After the acute seroconversion phase, the HIV virus will have been brought under control by the immune system, and the virus will have established a set point during which viral activity will remain more or less stable for a couple of months or years.

The next stage of infection following the acute phase is the chronic stage and is also referred to as clinical latency. This stage of infection is one in which the infection progressed silently with few or no symptoms. At this point, the virus continues to infect and deplete CD4 T-cells that are relied upon when the body needs an immune response to a trigger. As the CD4 T-cells continue to deplete in quantity, there is an increased risk of opportunistic infections as well as immune suppression. Opportunistic infections are so named because they only infect a weak immune system as a strong immune system would be able to subdue them.

Signs and complications of HIV in women

Chronic HIV infection has the symptoms related more to the development of opportunistic infections than the virus itself. This means that the secondary infections affecting a woman’s health and menstrual cycle usually develop as a result of prolonged immune suppression and chronic inflammation.

Note that CD4 T-cell count of 500 -1,200 cells per cubic millimeter is seen as normal, whereas a cell count of 250 – 500 per cubic millimeter is seen as a sign of immunosuppression. Also note that the types of opportunistic infections seen at a CD4 T-cell count of 250 -500 is more or less the same for both men and women. They include infections like herpes zoster, herpes simplex, bacterial and fungal infections, tuberculosis and HIV related meningitis. The symptoms for women include the following.

Vaginal ulcers: the virus most commonly associated with genital herpes is the Herpes simplex virus type 2. The risk of herpes increases in people with HIV with a CD4 count of less than 500. The first manifestation of HIV in women is usually vaginal herpes. This is usually the case when the infected person is co-infected with herpes simplex virus type 2.

Abnormal periods: Menstrual problems like the absence of menstruation (amenorrhea) and irregular menstruation (oligomenorrhea) is experienced more by women who have been infected with HIV. As the CD4 cell count drops, the risk increases. The key risk factors are said to be untreated HIV infection and low body mass index.

Bone problems: Osteoporosis is characterised by bones that break easily, loss of height, back pain and stooped posture. Although women who are in their post-menopausal stage are at an increased risk, those women who are infected with HIV face the risk four times more. Additionally, certain HIV drugs and hepatitis C infection have also been linked to increased bone mineral loss.

Impaired fertility: women with HIV are less able to control the effects of Pelvic Inflammatory Disease (PID) even with the help of treatment. This is as a result of the suppression of the immune system by HIV. For this reason, women who are infected with HIV and also have PID can face serious complications like infertility and ectopic pregnancy. In simple terms, this means that women with HIV suffer complications of PID than women without HIV.

Genital warts: Genital warts are commonly linked to Human Papillomavirus (HPV) and are also known as condylomas. Studies have shown that women with HIV are at greater risk of having HPV than those without HIV. This, in turn, increases the risk of cervical cancer.

Premature menopause:  this condition is defined as the onset of menopause or the experience of menopausal symptoms before the age of 40. This can sometimes happen for women who have HIV, women who have a low CD4 count or women who smoke. However, women who have HIV and are healthy tend to experience menopause around the usual age of 50.

Recurrent yeast infection: vaginal candidiasis is a condition that results from the overgrowth of a fungus called candida. The decline of the CD4 cells also leads to the frequency and severity of the yeast infection. This yeast infection is the counterpart to the one experienced by both men and women called oral thrush.

Acquired Immune Deficiency Syndrome (AIDS)

This is the third stage of the HIV infection and is characterised by symptomatic disease. All the immune defenses have been wiped out at this stage, leaving you in an immunocompromised state. Also, at this point, you are vulnerable to common and uncommon illnesses because your immune defences are low. Without the means of protection, you run the risk of having life-threatening illnesses which include infections and even cancer.

According to CDC, when you have the following, then you must have progressed to AIDS;

• When you have one of the 28 conditions that define AIDS irrespective of your CD4 count
• When your CD4 count is below 200 cells per cubic millimetre

AIDS-defining conditions are those diseases that are rarely seen outside of immunocompromised people, and include common opportunistic infections that have spread from their typical sites of infection.

Symptoms of aids in women

There is little variation between symptoms of AIDS in men and women. The variations are simply evidence that shows that women experience more significant cognitive decline and are more likely to experience signs of HIV encephalopathy (AIDS dementia complex) than men.

Invasive cervical cancer is one AIDS-defining condition that is exclusive to women. It is an advanced stage of cervical cancer whereby the cancerous cells have spread to the tissue in the deeper part of the cervix or other parts of the body. Note that ICC can affect women with HIV as well as women without. However, the risk is about 7 times greater for women with HIV.

Non–HIV related conditions

Several non-HIV-related conditions are commonly seen in people who have a long term infection. These conditions include cancers as well as diseases related to ageing that often develop 10 -15 years earlier in people with HIV.

Generally, this means that HIV can increase the risk of non-HIV-related diseases and cancers like heart attacks, stroke and cardiovascular diseases if left untreated. Women are mostly affected in this case. For example, women with HIV are at greater risk of developing heart disease more than men. Also, women with HIV who engage in anal sex are more likely to develop anal cancer. All this is a result of co-infection.

The key to living longer, even with HIV, is early diagnosis and treatment. In the absence of a cure, HIV patients, especially women, can live as long and as healthy as possible.

Find out all you need to know about HIV when you visit this website.