In one of the first large studies to focus solely on women with the virus that causes AIDS, Johns Hopkins researchers have set out to learn why infected women get ill faster, receive less medical attention and die sooner than do their male counterparts.
The five-year study, involving up to 1,600 women at four hospitals, was prompted partly by a growing concern that physicians are failing to recognize gynecological infections that may be early signs of infection with the human immunodeficiency virus (HIV).
Scientists directing the study cited increasing evidence yesterday that HIV predisposes women to vaginal yeast infections and cervical disorders, including cancer, but physicians often treat those conditions as isolated occurrences without considering the possibility that HIV could be the cause.
The result could be missed opportunities to diagnose HIV early and prescribe for women preventive medicine that could stave off full-blown AIDS.
"We don't want women to think that just because they have a vaginal infection they have HIV," said Liza Solomon, principal investigator of the study. "It's a common problem among women . . . but it may be a little more common and more intractable among women with HIV."
Johns Hopkins hopes to recruit 200 women this year, and an equal number next year, for the study. The three other institutions are Brown University in Providence, R.I.; Montifiore Hospital, Bronx, N.Y.; and Wayne State University, Detroit. Volunteers will be divided equally between women who carry the virus and those who don't but may be at risk.
"Most of the studies have been done on men," said Dr. David Vlahov, who is also directing the study. "The net effect is that we have very little information about the manifestations of HIV infection that are very specific to women."
Women with acquired immune deficiency syndrome were seen infrequently when the epidemic emerged in the early 1980s, but their number has multiplied in recent years. In Maryland, they account for 16 percent of the 4,600 cases diagnosed since 1981 -- but 21 percent of all cases reported so far this year.
"Because HIV has been seen as a predominantly male disease, clinicians may be less likely to suspect HIV infection in a woman who comes in with immunosuppressive conditions," Dr. Vlahov said, referring to infections and cancers that strike people with weakened defenses.
The study might explain whether the frustrating experiences of a 38-year-old Baltimore illustrator, diagnosed with HIV last year, are commonplace. The woman, who spoke on condition on anonymity, recalled yesterday how her personal physician failed altogether to recognize a telltale sign of HIV infection.
In April of that year, she went to the doctor because of a nagging sore throat and mounting fatigue. When the antibiotics he prescribed failed, he advised her to consult a dentist. Why? He said a dentist might be able to explain the white streaks that riddled her mouth and throat, making them painfully raw.
Thinking the advice strange, she resorted to some home remedies until she decided to see her gynecologist about two separate problems -- a yeast infection and an abnormally long menstrual period. That doctor drew a connection between the gynecological problems and the white streaks, and ordered a blood test that confirmed the woman was infected with HIV.
The white streaks, he recognized, were thrush, a well-known fungal infection that strikes men and women whose immune systems are in decline.
Today, she credits him with making a diagnosis that had completely eluded the first doctor. But she complains that the gynecologist did little more than tell her she was HIV-positive. She had to go elsewhere to learn what to expect and where to get specialized care.
"He basically put everything on me," she said. "I thought I had two weeks to live, didn't know it was a slow process," she said. Through the Health Education Resources Organization's AIDS hot line, she received an appointment with a counselor and referrals to a doctor who specializes in HIV and to a support group.