Book Review

HIV Infection in Women

N Engl J Med 1995; 332:1388May 18, 1995

Article

HIV Infection in Women
Edited by Howard Minkoff, Jack A. DeHovitz, and Ann Duerr. 328 pp. New York, Raven Press, 1995. $98. ISBN: 0-7817-0236-4

Women account for about half the adults infected with the human immunodeficiency virus (HIV) throughout the world. In addition, women are affected by the HIV epidemic, as mothers, wives, companions, and providers of care to those infected by the virus. However, in almost every society women have fewer rights and opportunities than men. Poor women, who have been affected disproportionally in the epidemic, have even more restrictions on their lives than other women. This excellent book provides advice to clinicians about how to care for HIV-infected women in the context of the responsibilities, restraints, and often limited resources of these women.

The book contains 16 chapters written primarily by well-known investigators of HIV infection in women, including Peter Selwyn, Lorraine Sherr, Sten Vermund, Susan Chu, and Howard Minkoff. It is a well-written and well-edited book, with almost 1500 references and two parts. The first part explains what is known about HIV infection in women and includes chapters on epidemiology, virology, pathophysiology, psychology, and sociology. The second part describes in practical terms how to care for HIV-infected women and contains chapters on medical management, obstetrics, cervical disease, contraception, issues related to substance abuse, and HIV counseling and testing. The final two chapters of the book discuss how to start a clinic for HIV-infected women and the ethics of HIV screening of newborns.

Several distinctive features contribute to the excellence of the book. While explaining the science and medicine of HIV infection, the authors remain sensitive to the needs and circumstances of HIV-infected women. This perspective will help clinicians establish more collaborative relationships with their patients and thus provide better care. Another feature of the book is the evenhandedness of discussions about controversial issues. Conflicting study results are presented nonjudgmentally on such topics as the impact of pregnancy on the clinical course of HIV infection and the effect of hormonal contraception on the acquisition of HIV. The book also includes several viewpoints on important problems. For example, the chapter on psychology overlaps and enhances the chapter on sociology, and the chapters on heterosexual transmission of HIV and sexually transmitted diseases are distinctive but complementary.

Several chapters deserve special mention. The one on virology and pathophysiology by Alash'le Abimiku and Robert Gallo is concise and easily understandable and includes an excellent description of screening assays. Lorraine Sherr's insightful chapter on the psychosocial aspects of providing care for HIV-infected women should probably be required reading for anyone involved in the care of these women. The chapter “Human Papillomavirus Infection,” by Sten Vermund and Sandra Melnick, is the best review of cervical disease in HIV-infected women to date. Also, Patricia Kelly's chapter about starting a clinic for HIV-infected women contains an excellent summary of related issues.

The principal problem is how quickly books about HIV infection and AIDS become dated. For example, this book contains only a few paragraphs about the results of AIDS Clinical Trials Group study 076, which evaluated the use of zidovudine in pregnancy, probably because only preliminary information about the study was available at the time the book was written. In addition, it does not include enough information about several important topics. Despite some important differences, the pathophysiology of HIV infection in women is remarkably similar to that in men. Thus, important clinical information about HIV-associated diseases that are common to both men and women, such as Pneumocystis carinii pneumonia, deserves more emphasis in the book and elsewhere. In addition, hormonal contraceptives are discussed, but the book contains little specific information about levonorgestrel (Norplant) and medroxyprogesterone acetate (Depo-Provera). These hormonal contraceptives may be appropriate for women who use drugs who choose not to use condoms but still wish to prevent pregnancy.

This book is highly recommended for clinicians who care for women, especially obstetrician–gynecologists and infectious-disease specialists, as well as for medical students and residents, and for HIV-infected women who would like to have a better understanding of their disease. Those who need to learn more about HIV-infected women will find the book enlightening, comprehensive, and easy to read, and those who need a reference book will find it an extremely useful addition to their personal libraries.

Tedd V. Ellerbrock, M.D.
Centers for Disease Control and Prevention, Atlanta, GA 30329