Natural history of HIV infection in women

Hormone replacement therapy and risk for neurodegenerative diseases

Over the past two decades, there has been a significant amount of research investigating the risks and benefits of hormone replacement therapy (HRT) with regards to neurodegenerative disease. Here, we review basic science studies, randomized clinical trials, and epidemiological studies, and discuss the putative neuroprotective effects of HRT in the context of Alzheimer's disease, Parkinson's disease, frontotemporal dementia, and HIV-associated neurocognitive disorder. Findings to date suggest a reduced risk of Alzheimer's disease and improved cognitive functioning of postmenopausal women who use 17β-estradiol. With regards to Parkinson's disease, there is consistent evidence from basic science studies for a neuroprotective effect of 17β-estradiol; however, results of clinical and epidemiological studies are inconclusive at this time, and there is a paucity of research examining the association between HRT and Parkinson's-related neurocognitive impairment. Even less understood are the effects of HRT on risk for frontotemporal dementia and HIV-associated neurocognitive disorder. Limits to the existing research are discussed, along with proposed future directions for the investigation of HRT and neurodegenerative diseases.

Positive self-management program for women living with HIV: a descriptive analysis

There is an increasing need for community-based interventions to help women living with HIV better manage their symptoms and self-care. The investigators conducted a small descriptive pilot study to assess whether women living with HIV needed and wanted a community-based symptom management workshop, such as the Positive Self-Management Program (PSMP). A total of 7 HIV-infected adult women participated in five, 2-hour semi-structured focus groups and completed a brief survey on demographic information, HIV medications, HIV symptoms, and self-efficacy. Quantitative and qualitative data are presented. This pilot study suggests that urban-dwelling, HIV-infected women are interested in participating in a community-based, peer-led intervention and that the program may facilitate symptom management. Nurses caring for women living with HIV should consider referring their patients to community-based, peer-led programs that teach symptom management strategies.

The impact of migration on HIV prevention for women: constructing a conceptual framework

There are an estimated 40.5 million people currently living with HIV globally, 17.5 million of whom are women, according to the AIDS Epidemic update: December 2005, conducted by UNAIDS and the World Health Organization (WHO) 2005. Women are vulnerable to HIV for biologic as well as social reasons. In the past, the HIV prevention theorists have not considered the context of women's lives: factors at the individual, relationship, and community levels, as well as structural factors (both policy and cultural) impact on HIV prevention for women. This is particularly true for migrant women, who may be especially vulnerable to HIV infection during their time of transition. Throughout this article I explore the international literature for both the historical context of HIV prevention for women and the impact of migration on HIV risk for women. The literature review provides a basis for the development of a conceptual framework of the socioecologic factors affecting HIV prevention for migrant women. I call for consideration of the broad context of women's experience when developing interventions for this population.

Baseline characteristics of participants in the oral health component of the Women's Interagency HIV Study

OBJECTIVES

This study described baseline sociodemographic and oral health characteristics of a subset of HIV sero-positive and sero-negative women who participated in the oral health component of the Women's Interagency HIV Study (WIHS).

METHODS

In 1995-96, 584 HIV sero-positive and 151 sero-negative women from five WIHS core sites were enrolled in the oral study. Data on oral mucosa, salivary glands, dentition and periodontium, along with demographics, socioeconomics, and behavioral characteristics, were used to characterize this population.

RESULTS

Mean (SD) age was 37 (8) years for HIV sero-positive and 36 (8) years for sero-negative women; 27% of sero-positive women had CD4 counts < or =200 and 34% had viral loads >50,000 copies/ml. Sero-positive and sero-negative women were similar demographically, as well as on plaque index, gingival bleeding, linear gingival banding, and numbers of DMF teeth and surfaces, but sero-positive women had more abnormal gingival papilla (P = 0.004) and fewer teeth (P = 0.01). Among sero-positive women, those with <200 CD4 counts had more DMF teeth (P = 0.007), and the number of DMF surfaces increased with decreasing CD4 counts (P = 0.04). Sero-positive women who fit the Center for Disease Control (CDC) AIDS criteria were also more likely to have more DMF teeth (P = 0.004), DMF surfaces (P = 0.003), and decayed and/or filled (DF) root surfaces (P = 0.0002) compared to sero-positive women without AIDS.

CONCLUSIONS

Dental and periodontal variables showed little difference between HIV sero-positive and sero-negative women. Among sero-positive women, there were significant differences in coronal and root caries by AIDS diagnostic criteria, but no periodontal indicators by either AIDS diagnostic criteria or CD4 status, were observed.

Adherence to antiretroviral therapy among women with HIV infection

OBJECTIVE

The overall objective of this secondary analysis was to examine self-reported adherence to antiretroviral therapy in a sample of women with HIV.

DESIGN

The primary study used survey methodology.

SETTING

The setting included a university-based HIV/AIDS clinic in southwestern Pennsylvania and a community-based HIV/AIDS clinic in eastern Pennsylvania.

PARTICIPANTS

Sixty-one women infected with HIV who were taking protease inhibitors.

MAIN OUTCOME MEASURE

Self-reported adherence was based on responses to two questions: whether the person had missed a dose of her medications within the past 24 hours, and how many pills the person had taken on time as scheduled (none, very few, a few, about half, most, nearly all, all of them).

RESULTS

Adherence ranged from 60% to 75%. Two thirds (65.6%) of the sample thought that their medications were helping them; three fifths (57.4%) thought that it was dangerous to miss a dose of their medications.

CONCLUSIONS

Adherence in this sample was less than perfect, suggesting the need to develop, implement, and test interventions to promote better adherence to antiretroviral medication regimens among women with HIV.

The sexual behaviors of African American women living with HIV disease: is perceived HIV status altering sexual behavior?

The purpose of the study was to compare the sexual risk behaviors of heterosexual African American women living with HIV disease to women who perceive themselves to be HIV negative using a comparative descriptive design. Data were collected using a demographics questionnaire developed by the investigator and the Safe Sex Behavior Questionnaire (SSBQ). The HIV-positive sample was collected in two public service agencies that provide case management for HIV-positive individuals. The HIV-negative sample was collected in the surrounding community, populated primarily by low-income African Americans. The HIV-positive group demonstrated lower levels of income and education. Scores on the SSBQ indicated no statistical difference between the high-risk sexual behaviors of the HIV-positive and HIV-negative groups. No statistically significant difference was found in the reported past sexual experiences of the two groups, although mean SSBQ scores were higher in the HIV-positive group. The levels of sexual behaviors in both groups were consistent with the high-risk sexual behaviors of HIV-negative persons reported in the literature. This illustrates the need for nursing as a profession to improve programs directed toward altering the behaviors of those at high risk of contracting or transmitting HIV disease.

[Aids as underlying and associated causes of death, State of S. Paulo, Brazil, 1998]

OBJECTIVES

To describe the Aids mortality according to its underlying and associated causes of death in the State of S. Paulo in 1998.

METHODS

Mortality and population data for 1998 were obtained from the State Data Analysis System Department (Fundação Sistema Estadual de Análise de Dados - Seade). Causes of death were coded according to the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems.

RESULTS

Aids was the underlying cause in 4,619 deaths, corresponding to the 10th leading cause of death (2.0%) and a mortality rate of 13.1/100,000 population. Male/female death ratio and rate ratios were respectively 2.4 and 2.5. Aids was the second leading cause of death among men aged 20--34 and women aged 25--34 years. Median age at death for women (34.1+/-12.2 years old) was lower than men (36.4+/-10.7 years old) - p<0,001. The main associated causes of Aids deaths were respiratory insufficiency (36.1%), pneumonia (27.0%), tuberculosis (19.6%), septicemia (18.6%), toxoplasmosis (12.2%), P. carinii pneumonia (8.3%) and cachexia (7.9%). Aids was an associated cause of death in additional 84 cases. The main underlying causes of these deaths were malignant neoplasms (28/84), conditions secondary to alcohol abuse (23/84) and diabetes mellitus (7/84). The median age at death due to Aids as an underlying cause (35.7+/-11.2 years old) was lower than the age at death with Aids as an associated cause (39.9+/-11.8 years old - p<0.001).

CONCLUSIONS

Multiple causes of death allow to track part of the Aids natural history and provide additional data to develop adequate and specific preventive actions.

Position of the American Dietetic Association and Dietitians of Canada: women's health and nutrition

Within the past 10 years women's health has evolved to a much broader paradigm, beyond reproductive issues. From a physiological perspective, women's health now refers to the prevention, diagnosis, and management of conditions or diseases that may be unique to women, be more prevalent in women, or manifest differently in women than men. Women's health encompasses emotional, social, cultural, spiritual, and physical well-being. It is determined by the social, political, and economic context of women's lives. Nutrition is involved in the etiology or treatment of half of the 10 leading causes of death in women. The incidence of osteoporosis and extremes in body weight are approaching epidemic proportions in women. This position reviews the following health problems: cardiovascular disease, cancer, osteoporosis, weight, and diabetes mellitus. Dietetics professionals are in the perfect position to understand the issues surrounding women's health in order to deliver a message to women that will allow them to make wise decisions regarding their health. Nutrition is a critical component of risk reduction and treatment, and must be included in clinical and preventive services for women. Dietetics professionals must work to increase their knowledge about women's health issues, to promote health and education programs, to influence policy makers, to deliver the highest-quality medical nutrition therapy, and to be proactive in documenting the effectiveness of outcomes-based research.