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Zulaika G, Nyothach E, van Eijk AM, Obor D, Mason L, Wang D, Chen T, Kerubo E, Opollo V, Ngere I, Omondi Owino S, Oyaro B, ter Kuile FO, Kwaro D, Phillips-Howard P. Factors associated with the prevalence of HIV, HSV-2, pregnancy, and reported sexual activity among adolescent girls in rural western Kenya: A cross-sectional analysis of baseline data in a cluster randomized controlled trial. PLoS Med 2021; 18:e1003756. [PMID: 34582445 PMCID: PMC8478198 DOI: 10.1371/journal.pmed.1003756] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adolescence is a sensitive time for girls' sexual and reproductive health (SRH), as biological changes occur concurrently with heightening pressures for sexual activity. In western Kenya, adolescent girls are vulnerable to acquiring sexually transmitted infections (STIs), such as HIV and herpes simplex virus type 2 (HSV-2), and to becoming pregnant prior to reaching adulthood. This study examines associations between individual, household, and partner-related risk factors and the prevalence of sex, adolescent pregnancy, HIV, and HSV-2. METHODS AND FINDINGS We report baseline findings among 4,138 girls attending secondary school who were enrolled between 2017 and 2018 in the Cups or Cash for Girls (CCG) cluster randomized controlled trial in Siaya County, rural western Kenya. Laboratory confirmed biomarkers and survey data were utilized to assess the effects of girls' individual, household, and partner characteristics on the main outcome measures (adolescent reported sex, prior pregnancy, HIV, and HSV-2) through generalized linear model (GLM) analysis. Complete data were available for 3,998 girls (97%) with median age 17.1 years (interquartile range [IQR] 16.3 to 18.0 years); 17.2% were HSV-2 seropositive (n = 686) and 1.7% tested positive for HIV (n = 66). Sexual activity was reported by 27.3% girls (n = 1,090), of whom 12.2% had been pregnant (n = 133). After adjustment, orphanhood (adjusted risk ratio [aRR] 2.81, 95% confidence interval [CI] 1.18 to 6.71, p-value [p] = 0.020), low body mass index (BMI) (aRR 2.07; CI: 1.00 to 4.30, p = 0.051), and age (aRR 1.34, 1.18 to 1.53, p < 0.001) were all associated with HIV infection. Girls reporting light menstrual bleeding (aRR 2.42, 1.22 to 4.79, p = 0.012) for fewer than 3 days (aRR 2.81, 1.16 to 6.82, p = 0.023) were over twice as likely to have HIV. Early menarche (aRR 2.05, 1.33 to 3.17, p = 0.001) was associated with adolescent pregnancy and HSV-2-seropositive girls reported higher rates of pregnancy (aRR 1.62, CI: 1.16 to 2.27, p = 0.005). High BMI was associated with HSV-2 (aRR 1.24, 1.05 to 1.46, p = 0.010) and sexual activity (aRR 1.14, 1.02 to 1.28, p = 0.016). High levels of harassment were detected in the cohort (41.2%); being touched indecently conveyed the strongest association related to reported sexual activity (aRR 2.52, 2.26 to 2.81, p < 0.001). Study limitations include the cross-sectional design of the study, which informs on the SRH burdens found in this population but limits causal interpretation of associations, and the self-reported exposure ascertainment, which may have led to possible underreporting of risk factors, most notably prior sexual activity. CONCLUSIONS Our findings indicate that adolescent girls attending school in Kenya face frequent harassment for sex and are at high risk of pregnancy and HSV-2, with girls experiencing early menarche particularly vulnerable. Targeted interventions, such as earlier sexual education programs, are warranted to address their vulnerability to SRH harms. TRIAL REGISTRATION ClinicalTrials.gov NCT03051789.
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Affiliation(s)
- Garazi Zulaika
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
- * E-mail: (GZ); (PPH)
| | - Elizabeth Nyothach
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research, Kisumu, Kenya
| | | | - David Obor
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research, Kisumu, Kenya
| | - Linda Mason
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Duolao Wang
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Tao Chen
- Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Emily Kerubo
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research, Kisumu, Kenya
| | - Valarie Opollo
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research, Kisumu, Kenya
| | | | | | - Boaz Oyaro
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research, Kisumu, Kenya
| | | | - Daniel Kwaro
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research, Kisumu, Kenya
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Suarez-García I, Alejos B, Pérez-Elías MJ, Iribarren JA, Hernando A, Ramírez M, Tasias M, Pascual M, Jarrin I, Hernando V. How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort. BMC Womens Health 2021; 21:223. [PMID: 34049547 PMCID: PMC8162006 DOI: 10.1186/s12905-021-01370-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/21/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND To estimate the prevalence and severity of menopausal symptoms and anxiety/depression and to assess the differences according to menopausal status among women living with HIV aged 45-60 years from the cohort of Spanish HIV/AIDS Research Network (CoRIS). METHODS Women were interviewed by phone between September 2017 and December 2018 to determine whether they had experienced menopausal symptoms and anxiety/depression. The Menopause Rating Scale was used to evaluate the prevalence and severity of symptoms related to menopause in three subscales: somatic, psychologic and urogenital; and the 4-item Patient Health Questionnaire was used for anxiety/depression. Logistic regression models were used to estimate odds ratios (ORs) of association between menopausal status, and other potential risk factors, the presence and severity of somatic, psychological and urogenital symptoms and of anxiety/depression. RESULTS Of 251 women included, 137 (54.6%) were post-, 70 (27.9%) peri- and 44 (17.5%) pre-menopausal, respectively. Median age of onset menopause was 48 years (IQR 45-50). The proportions of pre-, peri- and post-menopausal women who had experienced any menopausal symptoms were 45.5%, 60.0% and 66.4%, respectively. Both peri- and post-menopause were associated with a higher likelihood of having somatic symptoms (aOR 3.01; 95% CI 1.38-6.55 and 2.63; 1.44-4.81, respectively), while post-menopause increased the likelihood of having psychological (2.16; 1.13-4.14) and urogenital symptoms (2.54; 1.42-4.85). By other hand, post-menopausal women had a statistically significant five-fold increase in the likelihood of presenting severe urogenital symptoms than pre-menopausal women (4.90; 1.74-13.84). No significant differences by menopausal status were found for anxiety/depression. Joint/muscle problems, exhaustion and sleeping disorders were the most commonly reported symptoms among all women. Differences in the prevalences of vaginal dryness (p = 0.002), joint/muscle complaints (p = 0.032), and sweating/flush (p = 0.032) were found among the three groups. CONCLUSIONS Women living with HIV experienced a wide variety of menopausal symptoms, some of them initiated before women had any menstrual irregularity. We found a higher likelihood of somatic symptoms in peri- and post-menopausal women, while a higher likelihood of psychological and urogenital symptoms was found in post-menopausal women. Most somatic symptoms were of low or moderate severity, probably due to the good clinical and immunological situation of these women.
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Affiliation(s)
- Ines Suarez-García
- Infectious Diseases Group, Department of Internal Medicine, Hospital Universitario Infanta Sofia, FIIB HUIS HHEN, Madrid, Spain
- Universidad Europea de Madrid, Madrid, Spain
| | - Belén Alejos
- National Center for Epidemiology, Institute of Health Carlos III, Avda. Monforte de Lemos, 5, 28029, Madrid, Spain
| | | | | | - Asunción Hernando
- Universidad Europea de Madrid, Madrid, Spain
- Instituto de Investigación Hospital Universitario Doce Octubre, Madrid, Spain
| | | | | | - Mario Pascual
- Institute of Health Carlos III, Telemedicine and E-Health Unit, Madrid, Spain
| | - Inma Jarrin
- National Center for Epidemiology, Institute of Health Carlos III, Avda. Monforte de Lemos, 5, 28029, Madrid, Spain
| | - Victoria Hernando
- National Center for Epidemiology, Institute of Health Carlos III, Avda. Monforte de Lemos, 5, 28029, Madrid, Spain.
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Valiaveettil C, Loutfy M, Kennedy VL, Caddy S, Yudin M, Conway T, Ding E, Sereda P, de Pokomandy A, Kaida A. High prevalence of abnormal menstruation among women living with HIV in Canada. PLoS One 2019; 14:e0226992. [PMID: 31881068 PMCID: PMC6934328 DOI: 10.1371/journal.pone.0226992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022] Open
Abstract
Objectives To measure the prevalence and correlates of abnormal menstruation among women living with HIV (WLWH) in Canada. Methods We used cross-sectional questionnaire data from the community-based Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS), which enrolled WLWH aged ≥16 from British Columbia (BC), Ontario, and Quebec. For this analysis, we excluded women >45 years, who had primary amenorrhea, were pregnant, on hormonal contraception, or who reported history of endometrial cancer, last menstrual period >12 months ago, or premature ovarian failure. The primary outcome was abnormal menstruation (Yes vs No) based on responses to five questions about menstrual regularity, frequency, volume, duration, and intermenstrual bleeding in the six months prior to interview. An exploratory multivariable logistic regression analysis examined independent correlates of abnormal menstruation. Results Of 1422 women enrolled, 521 (37%) met eligibility criteria. Overall, 55.9% (95% CI:52%-60%) reported abnormal menstruation. In adjusted analyses, abnormal menstruation was associated with having a biologic sister/mother who entered menopause before age 40 (AOR 5.01, 95%CI 1.39–18.03), Hepatitis B co-infection (AOR 6.97, 95%CI 1.52–31.88), current smoking (AOR 1.69, 95%CI 1.55–3.41); and currently taking antiretroviral therapy (ART) (AOR 2.36, 95%CI 1.25–4.45) compared to being ART-naïve. Women in BC had higher adjusted odds of abnormal menstruation (AOR 2.95, 95%CI 1.61–5.39), relative to women in Ontario and Quebec. Conclusions Over half of WLWH in this analysis had abnormal menstruation. Correlates of abnormal menstruation include genetic, socio-behavioural factors (province of residence, smoking), Hepatitis B co-infection, and current ART use.
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Affiliation(s)
| | - Mona Loutfy
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - V. Logan Kennedy
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Sheila Caddy
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada
| | - Mark Yudin
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Obstetrics and Gynecology, St. Michael’s Hospital, Toronto, ON, Canada
| | - Tracey Conway
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Erin Ding
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- * E-mail:
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Godwin CL, Wohl DA, Fischer Nd WA, Singh K, Hawks DA, Devore EE, Brown J. Reproductive health sequelae among women who survived Ebola virus disease in Liberia. Int J Gynaecol Obstet 2019; 146:212-217. [PMID: 31074837 DOI: 10.1002/ijgo.12858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 12/17/2018] [Accepted: 04/16/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To estimate the incidence of failed pregnancy and menstrual irregularities among Liberian women who had survived Ebola virus disease (EVD) and to identify host-specific and disease-specific factors associated with these outcomes. METHODS A cross-sectional questionnaire-based study was conducted between August 10, 2016, and February 7, 2017. The study population comprised 111 women aged 18-45 years who had survived EVD and were enrolled in the Longitudinal Liberian Ebola Survivor study based at the Eternal Love Winning Africa Hospital, Monrovia, Liberia. Self-reported data on outcomes related to pregnancy and menstrual changes since recovery from EVD were collected. RESULTS In all, 29 (26.1%) of the participants had become pregnant since surviving EVD. Of the 23 women whose pregnancies continued to term, 10 (43.4%) reported live birth, 11 (47.8%) reported spontaneous abortion, and two (8.7%) reported stillbirth. Of the 105 women who reported having regular menstruation before EVD, 27 (29.0%) reported experiencing irregular menstruation for unknown reasons after EVD. In bivariate logistic models, no associations were found between failed pregnancy or irregular menstruation and any of the factors of interest. CONCLUSIONS Adverse pregnancy outcomes and irregular menstruation were frequently reported among EVD survivors in Liberia.
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Affiliation(s)
- Christine L Godwin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,FHI 360, Durham, NC, USA
| | - David A Wohl
- Division of Infectious Disease, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - William A Fischer Nd
- Division of Pulmonary and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kavita Singh
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Darrell A Hawks
- Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Elizabeth E Devore
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jerry Brown
- Eternal Love Winning Africa Hospital, Monrovia, Liberia
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Abstract
OBJECTIVE There is conflicting literature to support a link between HIV and amenorrhea. Here, we conduct a meta-analysis to summarize the results from landmark studies in this area and shed light on this important clinical association. METHODS Using a search of Ovid Medline and Embase, a total of 322 articles were screened for controlled matched observational studies of amenorrhea in premenopausal women living with HIV (WLWH). For inclusion, amenorrhea was defined as absence of menses for 3 months or longer. The meta-analysis used a random-effects model with an I2 calculated to assess heterogeneity. RESULTS Six studies from 1996 to 2010 were included in our analysis for a total of 8925 women (6570 WLWH). There was a significant association between HIV status and amenorrhea (OR 1.68, P value 0.0001) without evidence of heterogeneity (I2: 0.0%). In the majority of studies, there was no significant difference in substance use, smoking, or socioeconomic status between WLWH and controls. Additionally, in the majority of studies, amenorrhea in the setting of low BMI was significantly more frequent in WLWH than controls. CONCLUSION This meta-analysis provides a large population assessment of amenorrhea in HIV to suggest increased prevalence of menstrual disturbances in WLWH. It lends evidence suggestive that this relation is independent of substance use and socioeconomic status, but may be related to low BMI. Our findings reinforce the importance of routine assessment of reproductive health and time of last menstrual period as part of the health assessment of women, especially those living with HIV.
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Agaba P, Meloni S, Sule H, Ocheke A, Agaba E, Idoko J, Kanki P. Factors associated with early menopause among women in Nigeria. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30333-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
OBJECTIVE To evaluate HIV directly or indirectly related altered ovarian function, using serum anti-Müllerian hormone (AMH) levels in HIV-infected women as compared with seronegative women. DESIGN We conducted a matched cohort study from January 2008 to December 2013 in a tertiary university centre. Two hundred and one HIV-infected women requesting assisted reproductive technology and 603 age and cause of infertility-matched HIV seronegative women were enrolled in this study. METHODS All data were prospectively collected using a semistructured questionnaire. Serum AMH levels in HIV-infected women and matched controls were compared. To find out the contributing factors to increased serum AMH levels in HIV-infected women, a backward multiple linear regression was performed. RESULTS Serum AMH levels were significantly lower in HIV-infected group as compared with seronegative controls (3.0 ± 2.8 vs 3.7 ± 3.5 ng/ml; respectively, P = 0.001). Looking for factors associated with altered AMH among HIV-infected women, an association has been shown between tubal disease and a further decrease in serum AMH levels (2.4 ± 2.4 vs 3.4 ± 3.0 ng/ml; respectively, P = 0.011). Among HIV-infected women, after multivariate linear regression analysis, we showed that increased age, BMI and viral load were associated with decreased serum AMH levels whereas in striking contrast an increase in CD4⁺ cell count was associated with an increase of serum AMH levels. CONCLUSION Serum AMH levels were lower in the HIV-infected group than in the control group. Age, BMI, CD4⁺ cell count and viral load were the independent contributors affecting serum AMH levels among HIV-infected women.
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Abstract
Since the implementation of effective combination antiretroviral therapy, HIV infection has been transformed from a life-threatening condition into a chronic disease. As people with HIV are living longer, aging and its associated manifestations have become key priorities as part of HIV care. For women with HIV, menopause is an important part of aging to consider. Women currently represent more than one half of HIV-positive individuals worldwide. Given the vast proportion of women living with HIV who are, and will be, transitioning through age-related life events, the interaction between HIV infection and menopause must be addressed by clinicians and researchers. Menopause is a major clinical event that is universally experienced by women, but affects each individual woman uniquely. This transitional time in women's lives has various clinical implications including physical and psychological symptoms, and accelerated development and progression of other age-related comorbidities, particularly cardiovascular disease, neurocognitive dysfunction, and bone mineral disease; all of which are potentially heightened by HIV or its treatment. Furthermore, within the context of HIV, there are the additional considerations of HIV acquisition and transmission risk, progression of infection, changes in antiretroviral pharmacokinetics, response, and toxicities. These menopausal manifestations and complications must be managed concurrently with HIV, while keeping in mind the potential influence of menopause on the prognosis of HIV infection itself. This results in additional complexity for clinicians caring for women living with HIV, and highlights the shifting paradigm in HIV care that must accompany this aging and evolving population.
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Affiliation(s)
- Nisha Andany
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - V Logan Kennedy
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Muna Aden
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Mona Loutfy
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
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Hoyt MJ, Storm DS, Aaron E, Anderson J. Preconception and contraceptive care for women living with HIV. Infect Dis Obstet Gynecol 2012; 2012:604183. [PMID: 23097595 PMCID: PMC3477542 DOI: 10.1155/2012/604183] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 06/04/2012] [Indexed: 02/06/2023] Open
Abstract
Women living with HIV have fertility desires and intentions that are similar to those of uninfected women, and with advances in treatment most women can realistically plan to have and raise children to adulthood. Although HIV may have adverse effects on fertility, recent studies suggest that antiretroviral therapy may increase or restore fertility. Data indicate the increasing numbers of women living with HIV who are becoming pregnant, and that many pregnancies are unintended and contraception is underutilized, reflecting an unmet need for preconception care (PCC). In addition to the PCC appropriate for all women of reproductive age, women living with HIV require comprehensive, specialized care that addresses their unique needs. The goals of PCC for women living with HIV are to prevent unintended pregnancy, optimize maternal health prior to pregnancy, improve maternal and fetal outcomes in pregnancy, prevent perinatal HIV transmission, and prevent HIV transmission to an HIV-uninfected sexual partner when trying to conceive. This paper discusses the rationale for preconception counseling and care in the setting of HIV and reviews current literature relevant to the content and considerations in providing PCC for women living with HIV, with a primary focus on well-resourced settings.
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Affiliation(s)
- Mary Jo Hoyt
- François-Xavier Bagnoud Center, School of Nursing, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, USA.
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Zhang Y, Margolese S, Yudin MH, Raboud JM, Diong C, Hart TA, Shapiro HM, Librach C, Gysler M, Loutfy MR. Desires, Need, Perceptions, and Knowledge of Assisted Reproductive Technologies of HIV-Positive Women of Reproductive Age in Ontario, Canada. ISRN OBSTETRICS AND GYNECOLOGY 2012; 2012:853503. [PMID: 22957265 PMCID: PMC3431126 DOI: 10.5402/2012/853503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 06/03/2012] [Indexed: 11/23/2022]
Abstract
The purpose of this cross-sectional study is to assess the desire, need, perceptions, and knowledge of assisted reproductive technologies (ARTs) for women living with HIV (WLWHIV) and determine correlates of ART knowledge desire. WLWHIV of reproductive age were surveyed using the survey instrument "The HIV Pregnancy Planning Questionnaire" at HIV/AIDS service organizations across Ontario, Canada. Of our cohort of 500 WLWHIV, median age was 38, 88% were previously pregnant, 78% desired more information regarding ART, 59% were open to the idea of receiving ART, 39% felt they could access a sperm bank, and 17% had difficulties conceiving (self-reported). Age, African ethnicity, and residence in an urban center were correlated with desire for more ART information. Of participants, 50% wanted to speak to an obstetrician/gynecologist regarding pregnancy planning, and 74% regarded physicians as a main source of fertility service information. While the majority of participants in our cohort desire access to ART information, most do not perceive these services as readily accessible. Healthcare practitioners were viewed as main sources of information regarding fertility services and need to provide accurate information regarding access. Fertility service professionals need to be aware of the increasing demand for ART among WLWHIV.
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Affiliation(s)
- Yimeng Zhang
- Women and HIV Research Program, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada M5G 1N6
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada M5S 3K1
| | - Shari Margolese
- Women and HIV Research Program, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada M5G 1N6
| | - Mark H. Yudin
- Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada M5B 1W8
| | - Janet M. Raboud
- Clinical Decision Making and Health Care, University Health Network, Toronto, ON, Canada M5G 2C4
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada M5S 1A1
| | - Christina Diong
- Clinical Decision Making and Health Care, University Health Network, Toronto, ON, Canada M5G 2C4
| | - Trevor A. Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada M5S 1A1
- Department of Psychology, Ryerson University, Toronto, ON, Canada M5B 2K3
| | - Heather M. Shapiro
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada M5G 1X5
| | - Cliff Librach
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada M4N 3M5
| | - Matt Gysler
- Department of Obstetrics and Gynecology, Credit Valley Hospital, Mississauga, ON, Canada L5M 2N1
| | - Mona R. Loutfy
- Women and HIV Research Program, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada M5G 1N6
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada M5S 3K1
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Cejtin HE. Care of the human immunodeficiency virus-infected menopausal woman. Am J Obstet Gynecol 2012; 207:87-93. [PMID: 22284959 PMCID: PMC3408554 DOI: 10.1016/j.ajog.2011.12.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 12/07/2011] [Accepted: 12/27/2011] [Indexed: 10/14/2022]
Abstract
More women than ever before are both human immunodeficiency virus infected and menopausal, because of increased survival and more frequent diagnosis in older women. Such a woman has the combined burden of her infection, its treatment, comorbid conditions, and aging. Thus, she is at risk for a variety of problems, such as disorders of bone mineral density and deficiencies in cognitive functioning. In addition to this, she experiences menopause in a unique fashion, with more symptoms and perhaps at an earlier age. The clinician caring for her must take a proactive approach to this multitude of factors that may affect her health and well-being.
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Affiliation(s)
- Helen Elizabeth Cejtin
- Department of Obstetrics and Gynecology, John H. Stroger Hospital of Cook County, Chicago, IL, USA.
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Kushnir VA, Lewis W. Human immunodeficiency virus/acquired immunodeficiency syndrome and infertility: emerging problems in the era of highly active antiretrovirals. Fertil Steril 2011; 96:546-53. [PMID: 21722892 DOI: 10.1016/j.fertnstert.2011.05.094] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 05/31/2011] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review the effects of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in terms of its associated comorbid conditions and the side effects of antiretroviral treatment on fertility. DESIGN PubMed computer search to identify relevant articles. SETTING Research institution. PATIENT(S) None. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) None. RESULT(S) Biological alterations in reproductive physiology may account for subfertility in patients infected with HIV. Psychosocial factors in patients with HIV infection may affect their reproductive desires and outcomes. Antiretroviral medications may have direct toxicity on gametes and embryos. Available evidence indicates that fertility treatments can be a safe option for couples with HIV-discordant infection status, although the potential risk of viral transmission cannot be completely eliminated. CONCLUSION(S) Because their potential reproductive desires are increasingly becoming a concern in the health care of young HIV-infected patients, additional data are needed to address the effect of HIV and its treatments on their fertility and reproductive outcomes.
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Affiliation(s)
- Vitaly A Kushnir
- Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia 30312, USA.
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Ezechi OC, Jogo A, Gab-Okafor C, Onwujekwe DI, Ezeobi PM, Gbajabiamila T, Adu RA, Audu RA, Musa AZ, Salu OB, Meschack E, Herbertson E, Odunukwe N, Idigbe OE. Effect of HIV-1 infection and increasing immunosuppression on menstrual function. J Obstet Gynaecol Res 2011; 36:1053-8. [PMID: 21058440 DOI: 10.1111/j.1447-0756.2010.01253.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to determine the prevalence, pattern and determinants of menstrual abnormalities in HIV-positive Nigerian women. METHODS A cross-sectional study was carried out involving 3473 (2549 HIV-seropositive and 924 seronegative) consecutive and consenting women seen at the HIV treatment centers at the Nigerian Institute of Medical Research, Lagos and the Federal Medical Centre, Markurdi. RESULTS The sociodemographic characteristics of the two groups were comparable, except for body mass index (BMI): the HIV-negative women (28.1 ± 8.1) had statistically significantly (P < 0.005) higher BMI compared to the HIV-positive women (21.9 ± 7.5). Menstrual abnormalities were significantly more common in women living with HIV/AIDS (29.1%) compared to the HIV-negative (18.9%) women (P < 0.001). The proportions of women in the two groups with intermenstrual bleeding, menorrhagia, hypermenorrhea, and postcoital bleeding were similar (P > 0.005), however amenorrhea, oligomenorrhea, irregular periods and secondary dysmenorrhea were more common in the HIV-positive women (P < 0.02). Primary dysmenorrhea was less common in HIV-positive women (P < 0.03). Among the HIV-positive women, menstrual dysfunction was more common in women living with HIV/AIDS with opportunistic infections, CD4 count < 200, not undertaking therapy, symptomatic disease and BMI < 20. However, after controlling for cofounders, only CD4 < 200 (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.2-9.7), BMI < 20 (OR, 2.4; 95%CI, 1.3-3.5) and not taking antiretroviral drugs (OR, 2.05; CI, 1.7-6.5) were associated with amenorrhea, oligomenorrhea, irregular periods and secondary dysmenorrhea. CONCLUSION HIV-positive women in this study experienced more menstrual abnormalities of amenorrhea, oligomenorrhea, and irregular periods compared to the HIV-negative controls. HIV-positive women with CD4 count < 200, BMI < 20 and who do not take antiretroviral drugs are at the greatest risk.
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Affiliation(s)
- Oliver C Ezechi
- Sexual and Reproductive Health Research Unit, Clinical Sciences Division, Nigerian Institute of Medical Research, Lagos, Nigeria. oezechi@ yahoo.co.uk
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Santulli P, Gayet V, Fauque P, Chopin N, Dulioust E, Wolf JP, Chapron C, de Ziegler D. HIV-positive patients undertaking ART have longer infertility histories than age-matched control subjects. Fertil Steril 2011; 95:507-12. [DOI: 10.1016/j.fertnstert.2010.09.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 08/29/2010] [Accepted: 09/14/2010] [Indexed: 11/17/2022]
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Abstract
UNLABELLED Human reproduction provides unique opportunities for the transmission of infectious agents. Furthermore, the mother and her offspring have distinct susceptibilities to infection at each stage of reproduction, from conception and gestation to parturition and the neonatal period. The impact of pathogens on reproduction can be mitigated or exacerbated depending on timing of acquisition during pregnancy. Similarly, factors such as maternal immune response, nutritional status, or concurrent infection may modify the effect of an infectious agent. In this review, we discuss the evidence--or lack thereof--for associations between infectious agents and reproductive problems at each stage of reproduction. We focus on well-substantiated associations, and consider several emerging or controversial associations. We discuss the challenges, limitations, and opportunities related to epidemiologic research on infectious disease and reproductive outcomes. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader will be able to describe the potential mechanisms by which infectious agents may impact productive health, explain the public health impact of infectious diseases on reproductive health, and summarize the perinatal risks of infectious disease and relate this to treatment and prevention strategies in practice.
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Makanani B, Kumwenda J, Kumwenda N, Chen S, Tsui A, Taha TE. Resumption of sexual activity and regular menses after childbirth among women infected with HIV in Malawi. Int J Gynaecol Obstet 2010; 108:26-30. [PMID: 19782980 DOI: 10.1016/j.ijgo.2009.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 07/27/2009] [Accepted: 08/26/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the factors associated with resumption of sexual activity and regular menses after childbirth among women infected with HIV-1. METHODS Information on sociodemographic, behavioral, and clinical factors was obtained from 2 HIV perinatal studies (NVAZ and PEPI trials) conducted in Malawi, 2000-2009. Factors associated with resumption of sexual activity and menses were analyzed using Cox proportional hazard models. RESULTS A total of 1838 women from the NVAZ study and 2982 women from the PEPI study were included in the analysis. Resumption of sexual activity was primarily associated with sociodemographic factors (e.g. in the PEPI study, marital status [adjusted hazard ratio (aHR) 0.56, P<0.001], use of contraceptive method [aHR 8.0, P<0.001], and breastfeeding [aHR 0.52, P<0.001]), whereas resumption of regular menses in the PEPI study was primarily associated with biological factors (e.g. plasma viral load [aHR 0.89, P<0.006], and breastfeeding [aHR 0.23, P<0.001). CONCLUSION HIV-infected women need adequate counseling to take into account their HIV infection status before resuming sexual activity after childbirth.
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Affiliation(s)
- Bonus Makanani
- Department of Obstetrics and Gynecology and Medicine, University of Malawi, Blantyre, Malawi
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Singh JA, Bandewar S, Singer PA. Sex, gender, and health biotechnology: points to consider. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2009; 9:15. [PMID: 19622163 PMCID: PMC2726121 DOI: 10.1186/1472-698x-9-15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 07/21/2009] [Indexed: 12/05/2022]
Abstract
Background Reproductive technologies have been extensively debated in the literature. As well, feminist economists, environmentalists, and agriculturalists have generated substantial debate and literature on gender. However, the implications for women of health biotechnologies have received relatively less attention. Surprisingly, while gender based frameworks have been proposed in the context of public health policy, practice, health research, and epidemiological research, we could identify no systematic framework for gender analysis of health biotechnology in the developing world. Discussion We propose sex and gender considerations at five critical stages of health biotechnology research and development: priority setting; technology design; clinical trials; commercialization, and health services delivery. Summary Applying a systematic sex and gender framework to five key process stages of health biotechnology research and development could be a first step towards unlocking the opportunities of this promising science for women in the developing world.
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Affiliation(s)
- Jerome Amir Singh
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa.
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Abstract
In this article, gynecologic conditions of increased importance in the HIV-infected woman are discussed. Women living with HIV may have an increase in menstrual disorders, lower genital tract neoplasias, gynecologic surgery, and sexually transmitted infections. The literature relevant to choosing a method of contraception for HIV-positive women is also discussed. With the advent of HAART, seropositive women are now facing issues around longevity, such as menopause and disorders of bone mineral density, as well as those associated with fertility.
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Affiliation(s)
- Helen E Cejtin
- Department of Obstetrics and Gynecology, John H. Stroger Jr Hospital of Cook County (formerly Cook County Hospital), 1901 W. Harrison, Chicago, IL 60612, USA.
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Prior J, Burdge D, Maan E, Milner R, Hankins C, Klein M, Walmsley S. Fragility fractures and bone mineral density in HIV positive women: a case-control population-based study. Osteoporos Int 2007; 18:1345-53. [PMID: 17665239 DOI: 10.1007/s00198-007-0428-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 04/11/2007] [Indexed: 11/26/2022]
Abstract
UNLABELLED This Canadian study of bone health showed that HIV+ women were more likely to have had fragility fractures (OR 1.7) but had BMD values that were not different than women from a national population-based cohort. INTRODUCTION Given that 17.5 million women globally are HIV-infected and living longer on anti-retroviral therapy (ART+), it is essential to determine whether they are at risk for osteoporosis as is currently assumed. METHODS Assessment of osteoporosis risk factors and lifetime low-trauma (fragility) fracture history used a common interviewer-administered questionnaire and phantom-adjusted bone mineral density (BMD). This study compared HIV+ Canadian women with age- and region-matched control women (1:3) from a national population-based study of osteoporosis. RESULTS One hundred and thirty-eight HIV+ women (100 ART+, 38 ART-) were compared with 402 controls. There were no differences in age (37.7 vs. 38.0 years), BMI (25.0 vs. 26.2), family history of osteoporosis, exercise history, alcohol or calcium intakes, age at menarche, oral contraceptive use or parity. HIV+ cases included more Aboriginal and Black women (12.5% and 16.2 vs. 2% and 1%, respectively), smoked and used injection drugs (53%) more, were more often treated with glucocorticoids, had oligomenorrhea, and reported 10-kg weight cycling. Significantly more HIV+ women reported lifetime fragility fractures (26.1% vs. 17.3; OR 1.7, 95% CI 1.1, 2.6). HIV+ and control women did not differ in BMD: spine 1.0 +/- 0.12 vs.1.0 +/- 0.14 g/cm(2) (diff. 0.0, 95% CI -0.27, 0.27) or total femur 0.91 +/- 0.15 vs. 0.93 +/- 0.12 g/cm(2) (diff 0.02, 95% CI +0.005, -0.045). CONCLUSION HIV+ women reported significantly more past osteoporotic fractures than population-based controls despite normal BMD. Research is needed to assess bone microarchitecture and develop a reliable fracture risk assessment tool for HIV+ women.
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Affiliation(s)
- J Prior
- Medicine/Endocrinology, University of British Columbia, Vancouver, Canada.
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Abstract
Many HIV-infected women are benefiting from highly active antiretroviral therapy and living longer. Their reproductive choices vary over the life cycle, and there is a need to understand the appropriate contraceptives for those not intending pregnancy. There are specific gynecologic issues relevant to HIV-infected women, such as genital tract infections, risk for cervical cancer, and menstrual irregularities. More women are expected to reach menopause. Health care providers should be aware of these unique needs of HIV-infected women.
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Affiliation(s)
- Erna Milunka Kojic
- Division of Infectious Diseases, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02806, USA.
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Kofteridis DP, Repa A, Anastasopoulos T, Barbounakis E, Gikas A, Karabekios S, Zaganas I. A case of human immunodeficiency virus infection disclosed by cytomegalovirus encephalitis. Int J Infect Dis 2007; 11:373-5. [PMID: 17331780 DOI: 10.1016/j.ijid.2006.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Revised: 10/26/2006] [Accepted: 11/07/2006] [Indexed: 10/23/2022] Open
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Seifer DB, Golub ET, Lambert-Messerlian G, Springer G, Holman S, Moxley M, Cejtin H, Nathwani N, Anastos K, Minkoff H, Greenblatt RM. Biologic markers of ovarian reserve and reproductive aging: application in a cohort study of HIV infection in women. Fertil Steril 2007; 88:1645-52. [PMID: 17418155 PMCID: PMC2682326 DOI: 10.1016/j.fertnstert.2007.01.122] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Revised: 01/25/2007] [Accepted: 01/26/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare Müllerian inhibiting substance (MIS) levels in serum obtained during the early follicular phase to those obtained randomly during the menstrual cycle. To determine whether HIV infection influences early follicular MIS levels, an early marker of ovarian aging. DESIGN A cross-sectional study. SETTING Women's Interagency HIV Study, a multicenter prospective study. PATIENT(S) Serum samples obtained from 263 (187 HIV infected and 76 uninfected) participants of the Women's Interagency HIV Study who reported menstrual bleeding during the preceding 6 months and who were not taking exogenous hormones. INTERVENTION(S) Early follicular (cycle days 2-5) MIS samples were compared with serum samples that had been obtained without regard to menstrual cycle phase. Comparison samples were obtained within 6 weeks before or within 3 to 6 months after the early follicular samples. Early follicular FSH, E(2), inhibin B, and MIS levels were also compared between the HIV infected and uninfected women. MAIN OUTCOME MEASURE(S) Correlation between early follicular MIS and prior and subsequent samples. Comparison of serum markers of ovarian reserve between HIV positive and negative women. RESULT(S) The MIS values from early follicular and other random cycle phases were highly correlated with each other (r > 0.93). In multivariate analysis, increased age and FSH level and lower inhibin B levels were associated with lower MIS level; MIS values did not vary by HIV serostatus. CONCLUSION(S) Without regard to cycle phase, MIS was similar during early follicular phase and highly correlated with early follicular FSH and inhibin B in women with and without HIV. Measurement of serum MIS offers a simplified method of determining ovarian reserve using specimens obtained without menstrual phase timing. Furthermore, using biologic measures of reproductive aging, we found no evidence that HIV infection influences ovarian aging.
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Affiliation(s)
- David B Seifer
- Maimonides Medical Center, Department of Obstetrics & Gynecology, Brooklyn, New York, USA.
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Ferreira CE, Pinto-Neto AM, Conde DM, Costa-Paiva L, Morais SS, Magalhães J. Menopause symptoms in women infected with HIV: prevalence and associated factors. Gynecol Endocrinol 2007; 23:198-205. [PMID: 17505939 DOI: 10.1080/09513590701253743] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence and factors associated with menopause symptoms in HIV-infected women. METHODS A cross-sectional study of two groups of women was conducted: 96 with HIV and 155 without HIV. Women aged 40 years or older, non-users of hormone therapy in the last 6 months and native Brazilians were included. The prevalence of menopause symptoms was calculated according to the studied variables. Symptoms were grouped into six categories: vasomotor, psychological, genitourinary, weight gain, palpitations and insomnia. The generalized estimating equation model was applied to identify the factors associated with menopause symptoms in all women and for HIV-infected women only. RESULTS The mean (+/-standard deviation) age of women with and without HIV was 48.9 +/- 7.4 and 51.0 +/- 8.7 years (p = 0.07), respectively. The median age at menopause for HIV-infected women was 47.5 years. Menopause symptoms were more frequent in HIV-infected women, highlighting psychological and vasomotor symptoms. HIV infection was associated with menopause symptoms (odds ratio (OR) = 1.65, p = 0.03), as well as age ranging from 45 to 54 years (OR = 1.77, p = 0.01), higher parity (OR = 2.38, p = 0.01) and self-perception of health as fair/poor (OR = 2.07, p < 0.01). Among HIV-infected women, the likelihood of presenting symptoms decreased in those aged 55 or older (OR = 0.16, p = 0.03) and increased in retired women (OR = 2.61, p = 0.02). CONCLUSION Menopause symptoms were common in HIV-infected women. HIV infection was independently associated with menopause symptoms, whereas age and being retired were associated with the occurrence of these symptoms in HIV-infected women.
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Affiliation(s)
- Carlos Eduardo Ferreira
- Department of Gynecology and Obstetrics, Universidade Estadual de Campinas, Campinas, Brazil
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Cejtin HE, Kalinowski A, Bacchetti P, Taylor RN, Watts DH, Kim S, Massad LS, Preston-Martin S, Anastos K, Moxley M, Minkoff HL. Effects of human immunodeficiency virus on protracted amenorrhea and ovarian dysfunction. Obstet Gynecol 2007; 108:1423-31. [PMID: 17138776 DOI: 10.1097/01.aog.0000245442.29969.5c] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To characterize ovarian failure and prolonged amenorrhea from other causes in women who are both human immunodeficiency virus (HIV) seropositive and seronegative. METHODS This was a cohort study nested in the Women's Interagency HIV Study, a multicenter U.S. study of HIV infection in women. Prolonged amenorrhea was defined as no vaginal bleeding for at least 1 year. A serum follicle stimulating hormone more than 25 milli-International Units/mL and prolonged amenorrhea were used to define ovarian failure. Logistic regressions, chi2, and t tests were performed to estimate relationships between HIV-infection and cofactors with both ovarian failure and amenorrhea from other causes. RESULTS Results were available for 1,431 women (1,139 HIV seropositive and 292 seronegative). More than one half of the HIV positive women with prolonged amenorrhea of at least 1 year did not have ovarian failure. When adjusted for age, HIV seropositive women were about three times more likely than seronegative women to have prolonged amenorrhea without ovarian failure. Body mass index, serum albumin, and parity were all negatively associated with ovarian failure in HIV seropositive women. CONCLUSION HIV serostatus is associated with prolonged amenorrhea. It is difficult to ascertain whether the cause of prolonged amenorrhea is ovarian in HIV-infected women without additional testing. LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- Helen E Cejtin
- John H. Stroger Hospital of Cook County, Chicago, Illinois 60626, and University of California, San Francisco, San Francisco, California, USA.
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Abstract
As the number of women living with HIV and AIDS increases, so does survival time for individuals living with this chronic condition. Symptom existence, intensity, and bothersomeness greatly affect quality of life in women living with HIV and AIDS. Symptoms experienced by women living with HIV include symptoms related to HIV infection itself, those related to opportunistic infections, and those related to medications and treatments. Symptoms experienced by women include those common to both genders and those specific to females. The presence and intensity of symptoms varies with progression of the disease and with deteriorating status of HIV disease indicators. While research is limited on this topic, some research on the general symptom experience of women and on symptoms specific to or common among women has been done. Extended life expectancy among women with HIV increases the importance of nursing care focused on symptom assessment and symptom management. This article reviews research on symptoms commonly experienced by women living with HIV and presents implications for the care of women experiencing distressing symptoms.
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Affiliation(s)
- Claire E Lindberg
- The College of New Jersey, School of Nursing, PO Box 7718, Ewing, NJ 08628, USA.
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Gilling-Smith C, Nicopoullos JDM, Semprini AE, Frodsham LCG. HIV and reproductive care—a review of current practice. BJOG 2006; 113:869-78. [PMID: 16753050 DOI: 10.1111/j.1471-0528.2006.00960.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In developed countries, antiretroviral treatment has increased life quality and expectancy of HIV-infected individuals and led to a drop in mother-to-child transmission (MCT) risk to below 1%. Fertility has been shown to be reduced in both men and women with HIV. As a result of these factors, the demand for reproductive care in this population is rising. In discordant couples where the man is positive, sperm washing significantly reduces viral transmission risk to the uninfected female partner over unprotected intercourse. Positive women do not necessarily need specialised fertility treatment but should be monitored closely during pregnancy to minimise MCT risk.
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Affiliation(s)
- C Gilling-Smith
- Assisted Conception Unit, Chelsea & Westminster Hospital, London, UK.
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Waters L, Barton S. Contraception and HIV: what do we know and what needs to be done? JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2006; 32:10-4. [PMID: 16492326 DOI: 10.1783/147118906775275055] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Laura Waters
- St Stephen's Centre, Department of Genitourinary and HIV Medicine, Chelsea & Westminster Hospital, London, UK.
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Sedgh G, Larsen U, Spiegelman D, Msamanga G, Fawzi WW. HIV-1 disease progression and fertility in Dar es Salaam, Tanzania. J Acquir Immune Defic Syndr 2005; 39:439-45. [PMID: 16010167 DOI: 10.1097/01.qai.0000148529.58963.83] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the association of HIV-1 disease progression with pregnancy and live birth incidence in a cohort of HIV-1-positive women in Dar es Salaam, Tanzania, and to identify other determinants of fertility in this population. DESIGN AND METHODS Clinic-based prospective cohort study of HIV-1-infected women followed for up to 6 years and Cox proportional hazards models. RESULTS The multivariate pregnancy rate ratio (RR) comparing women at clinical stage II with women at stage I was 0.56 (95% confidence interval [CI]: 0.39, 0.82), and the pregnancy RR for women at stage III or IV compared with women at stage I was 0.24 (95% CI: 0.16, 0.36), controlling for independent predictors of pregnancy incidence. Pregnancy rates were lower among older women, unmarried women, women who had revealed their HIV status to someone, and women who had living children from their most recent pregnancy. The association of HIV-1 clinical progression with a decline in pregnancy incidence was not explained by weight loss, menstrual dysfunction, or nutritional status. CONCLUSION Pregnancy and live birth rates decline dramatically with progression of HIV-1 disease. This decline is not explained by observed social, behavioral, or biologic factors.
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Affiliation(s)
- Gilda Sedgh
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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Miller SA, Santoro N, Lo Y, Howard AA, Arnsten JH, Floris-Moore M, Moskaleva G, Schoenbaum EE. Menopause symptoms in HIV-infected and drug-using women. Menopause 2005; 12:348-56. [PMID: 15879925 DOI: 10.1097/01.gme.0000141981.88782.38] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the association of HIV infection, drug use, and psychosocial stressors with type and frequency of menopause symptoms. DESIGN In a cross-sectional study, HIV-infected and HIV-uninfected midlife women underwent standardized interviews on menopause status and symptoms, demographic characteristics, depressive symptoms, negative life events, and substance abuse. Body mass index (BMI), HIV serostatus, and CD4 count were measured. Associations between study variables and menopause symptoms were assessed using generalized estimating equations. RESULTS Of 536 women not on hormone therapy, 48% were black, 42% were Hispanic, 54% were HIV positive, and 30% recently had used illicit drugs. The mean age was 45 +/- 5 years; 48% of the women were identified as premenopausal, and 37% were perimenopausal. Psychological symptoms were most prevalent (89%), followed by arthralgias (63%) and vasomotor symptoms (61%). Perimenopausal women reported significantly more menopause symptoms than premenopausal women (ORadj 1.34, 95% CI, 1.09-1.65). HIV-infected women were more likely to report menopause symptoms than uninfected women (ORadj 1.24, 95% CI, 1.02-1.51). Among HIV-infected women not on highly active antiretroviral therapy, symptoms decreased as the CD4 count declined. Increased menopause symptoms were significantly associated with depressive symptoms (ie, Center for Epidemiologic Studies Depression scale score > 23, ORadj1.82, 95% CI, 1.46-2.28), and with experiencing more than three negative life events (ORadj 2.08, 95% CI, 1.54-2.81). Increasing BMI (per kg/m) was also associated with more menopause symptoms (ORadj 1.03, 95% CI, 1.02-1.05). CONCLUSION HIV-infected women reported more menopause symptoms than HIV-uninfected women, but symptoms were less frequent in women with more advanced HIV disease. Depressive symptoms and negative life events were also highly associated with symptoms. Further study of menopause symptoms and HIV-related factors is warranted. Mental health interventions may also have a role in ameliorating menopause symptoms.
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Affiliation(s)
- Samantha A Miller
- Albert Einstein College of Medicine at Montefiore Medical Center, Bronx, New York 10467, USA
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Prins M, Meyer L, Hessol NA. Sex and the course of HIV infection in the pre- and highly active antiretroviral therapy eras. AIDS 2005; 19:357-70. [PMID: 15750389 DOI: 10.1097/01.aids.0000161765.75663.27] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We reviewed the available literature on the potential effects of sex on the course of HIV infection and found that there is little evidence for sex differences in the rate of disease progression in the pre-highly active antiretroviral therapy (HAART) and HAART era. Compared to men, women appeared to have lower HIV RNA levels and higher CD4 cell counts shortly after infection with HIV, but studies were inconclusive regarding whether these differences diminish over time. Differences in viral load or CD4+ cell count might cause women to delay initiation of HAART. Nonetheless, we found no substantial sex difference in the benefit of antiretroviral therapy. The studies we reviewed failed to find any harmful effect of pregnancy on HIV disease progression. With the availability of effective antiretroviral agents, HIV-infected women have increasingly decided to have children. Conflicting results exist on the effect of HAART on regression of cervical intra-epithelial neoplasia (CIN). Unlike CIN, invasive cervical cancer has not been found to be much higher in HIV-infected women than in HIV-uninfected women. Although publication bias cannot be ruled out, published studies suggest higher rates of adverse events among HIV-infected women on therapy as compared to men. As more pharmacological agents are developed, it is especially important that potential sex differences in pharmacodynamics are assessed. The relationship between metabolic abnormalities, changes in body habitus, and endocrine perturbations has not been extensively studied. Whether sex differences are due to unalterable genetic factors or social and environmental conditions, it is imperative that all HIV-infected individuals have equal access to interventions that can slow disease progression.
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Affiliation(s)
- Maria Prins
- Cluster Infectious Diseases, HIV and STI Research, Municipal Health Service, Amsterdam, The Netherlands.
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Harlow SD, Cohen M, Ohmit SE, Schuman P, Cu-Uvin S, Lin X, Greenblatt R, Gurtman A, Khalsa A, Minkoff H, Young MA, Klein RS. Substance use and psychotherapeutic medications: a likely contributor to menstrual disorders in women who are seropositive for human immunodeficiency virus. Am J Obstet Gynecol 2003; 188:881-6. [PMID: 12712080 DOI: 10.1067/mob.2003.209] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the impact of substance use and psychotherapeutic medications on menstrual characteristics in women who are human immunodeficiency virus seropositive and seronegative. STUDY DESIGN Menstrual calendars were prospectively collected for 1075 women who were human immunodeficiency virus seropositive and seronegative and who were enrolled in the Women's Interagency Human Immunodeficiency Virus Study or the Human Immunodeficiency Virus Epidemiology Research Study; several of the women were substance users or recipients of psychotherapeutic medications. RESULTS Women who received methadone maintenance and who used injection drugs had substantially increased odds of a cycle of >or=90 days (odds ratio, 2.28; 95% CI, 1.23-4.22; and odds ratio, 3.87; 95% CI, 2.16-6.95, respectively). The use of psychotherapeutic medications increased the odds of having very short cycles, <18 days, and cycles of >or=90 days (odds ratio, 1.69; 95% CI, 1.16-2.45; and odds ratio, 1.86; 95% CI, 1.03-3.36, respectively). CONCLUSION Clinicians should evaluate substance use, participation in methadone maintenance programs, and the use of psychotherapeutic medications and consider the neuroendocrinologic effects of these medications as a potential cause of menstrual disruptions.
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Affiliation(s)
- Siobán D Harlow
- Department of Epidemiology, University of Michigan, Ann Arbor, USA
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Affiliation(s)
- L al-Harthi
- Rush-Presbyterian St. Luke's Medical Center, Rush University, Chicago, Illinois, USA.
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