Fowler M G, Melnick S L, Mathieson B J
Efficacy Trials Branch, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Obstet Gynecol Clin North Am. 1997 Dec;24(4):705-29. doi: 10.1016/s0889-8545(05)70340-5.
The global HIV-1 epidemic in women continues to expand at an alarming rate. More than 11 million women are currently estimated to be HIV-infected, with the majority living in sub-Saharan Africa. The primary risk factor for HIV infection in women is unprotected heterosexual intercourse. Several cofactors may influence a woman's risk for HIV acquisition. These include the presence of other STDs, the prevalence of HIV in the population, engagement in high-risk sexual behaviors at a young age, an increased number of sexual partners, HIV illness severity in an infected partner, host immunogenetic responses, hormonal and other local effects in the female genital tract, and viral characteristics. The general clinical findings in women with HIV disease are similar to those in HIV-infected men. Some studies have noted higher rates of esophageal candidiasis and decreased rates of Kaposi's sarcoma in women when compared with men. Overall disease progression and survival in women and men are similar once an adjustment is made for other important risk factors such as the time of seroconversion, the receipt of antiretrovirals, and baseline CD4 cell counts. Women with HIV have a high frequency of a number of diseases of the reproductive tract, including low-grade cervical dysplasia and vulvovaginal candidiasis. Despite progress in understanding the risk factors for HIV transmission to women and the variables related to disease progression, major research questions remain. These include the role of hormonal contraceptives in the risk for HIV acquisition, the primary mechanism of infection, and host systemic as well as local hormonal and immune responses in the female reproductive tract that may alter the risk of HIV infection. Over the next decade, it is anticipated that the quality of life and length of survival will improve dramatically for both HIV-infected women and men in settings in which new highly active combination antiretroviral therapy is available and affordable. Unfortunately, in most of the world, these antiretroviral drugs are not available for the treatment of the vast numbers of individuals infected by HIV. Therefore, development of successful strategies for primary prevention of HIV infection in women must be a top public health priority.
全球女性感染艾滋病毒1型的疫情仍在以惊人的速度蔓延。目前估计有超过1100万女性感染了艾滋病毒，其中大多数生活在撒哈拉以南非洲地区。女性感染艾滋病毒的主要风险因素是无保护的异性性行为。几个辅助因素可能会影响女性感染艾滋病毒的风险。这些因素包括是否存在其他性传播疾病、人群中艾滋病毒的流行情况、年轻时从事高风险性行为、性伴侣数量增加、感染伴侣的艾滋病毒疾病严重程度、宿主免疫遗传反应、女性生殖道中的激素及其他局部影响，以及病毒特征。感染艾滋病毒的女性的一般临床症状与感染艾滋病毒的男性相似。一些研究指出，与男性相比，女性患食管念珠菌病的比例较高，患卡波西肉瘤的比例较低。一旦对其他重要风险因素进行调整，如血清转化时间、接受抗逆转录病毒药物治疗情况和基线CD4细胞计数，女性和男性的总体疾病进展和生存率相似。感染艾滋病毒的女性患多种生殖道疾病的频率较高，包括低度宫颈发育异常和外阴阴道念珠菌病。尽管在了解艾滋病毒传播给女性的风险因素以及与疾病进展相关的变量方面取得了进展，但主要的研究问题仍然存在。这些问题包括激素避孕药在感染艾滋病毒风险中的作用、感染的主要机制，以及女性生殖道中可能改变艾滋病毒感染风险的宿主全身以及局部激素和免疫反应。预计在未来十年，在有新的高效联合抗逆转录病毒疗法且可负担得起的情况下，感染艾滋病毒的女性和男性的生活质量和生存时间将大幅提高。不幸的是，在世界上大多数地区，这些抗逆转录病毒药物无法用于治疗大量感染艾滋病毒的人。因此，制定成功的女性艾滋病毒感染一级预防策略必须成为公共卫生的首要任务。
