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Perez-Fernandez J, Arroyo-Velasco DO, Huaman MR, Chavez-Bustamante SG, Llamo-Vilcherrez AP, Delgado-Flores CJ, Toro-Huamanchumo CJ. Association between early sexual initiation and sexually transmitted infections among Peruvian reproductive-age women. Front Public Health 2023; 11:1191722. [PMID: 37790721 PMCID: PMC10544918 DOI: 10.3389/fpubh.2023.1191722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
Background Sexually transmitted infections (STIs) are a serious public health problem worldwide, especially among reproductive-age women. The early sexual onset of sexual intercourse (EOSI) has been suggested as a risk factor, although there is no data at the national level. Objective To evaluate the association between EOSI and STIs in Peruvian women of childbearing age. Methods Analytical cross-sectional study with secondary data analyzes of the Peruvian Demographic and Family Health Survey 2018. The outcome was the presence of STIs in the last 12 months and the exposure variable was EOSI (age < 15 years at the time of their first sexual experience). To evaluate the association of interest, crude and adjusted prevalence ratios (aPRs) were calculated using generalized linear models with Poisson family and logarithmic link function. Results We analyzed data from 31,028 women of childbearing age. The 11.3% reported having STIs in the last 12 months and 20.2% of the participants had an EOSI. After adjusting for potential confounders, we found that EOSI was associated with STIs (aPR: 1.27; 95% CI: 1.08-1.50; p = 0.005). When conducting stratified analysis by area of residence and number of sexual partners, this association was maintained in women living in urban areas (aPR: 1.36; 95% CI: 1.11-1.66; p = 0.003) those who did not report having a history of multiple sexual partners (aPR: 1.27; 95% CI: 1.08-1.51; p = 0.005), and those in the middle (aPR: 1.42; 95% CI: 1.03-1.97; p = 0.034) and highest (aPR: 2.12; 95% CI: 1.33-3.39; p = 0.002) wealth quintiles. Conclusion Among reproductive-age women from Peru, EOSI was associated with STIs, especially in women living in urban areas, with no history of multiple sexual partners, and belonging to the middle to higher wealth index. The implementation of measures to prevent EOSI and fostering appropriate sexual health counseling for women with EOSI is advised.
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Affiliation(s)
| | | | - Mariella R. Huaman
- Sociedad Científica San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Anita P. Llamo-Vilcherrez
- Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Carolina J. Delgado-Flores
- Carrera de Farmacia y Bioquímica, Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru
| | - Carlos J. Toro-Huamanchumo
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- OBEMET Centro de Obesidad y Salud Metabólica, Lima, Peru
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2
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Thorsteinsson K, Ladelund S, Storgaard M, Katzenstein TL, Johansen IS, Pedersen G, Rönsholt FF, Nielsen LN, Nilas L, Franzmann M, Obel N, Lebech AM, Bonde J. Persistence of cervical high-risk human papillomavirus in women living with HIV in Denmark - the SHADE. BMC Infect Dis 2019; 19:740. [PMID: 31438877 PMCID: PMC6706931 DOI: 10.1186/s12879-019-4377-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/13/2019] [Indexed: 12/29/2022] Open
Abstract
Background Women living with HIV (WLWH) have high rates of persistent high-risk human papillomavirus (hrHPV) infections and cervical cancer. We aimed to assess the distribution of hrHPV genotypes, risk factors of type-specific hrHPV persistence, and high-grade squamous intraepithelial lesions or worse (≥HSIL) in WLWH in Denmark. Methods From the prospective Study on HIV, cervical Abnormalities and infections in women in Denmark (SHADE) we identified WLWH with a positive hrHPV test during the study period; 2011–2014. HIV demographics were retrieved from the Danish HIV Cohort Study and pathology results from the The Danish Pathology Data Bank. Logistic regression was used to identify risk factors associated with persistent hrHPV infection (positivity of the same hrHPV type in two samples one-two years after the first hrHPV positive date) and ≥ HSIL. Results Of 71 WLWH, 31 (43.7%) had persistent hrHPV infection. Predominant hrHPV genotypes were HPV58, 52, 51, and 35 and most frequently observed persistent genotypes were HPV52, 33 and 31. CD4 < 350 cells/μL predicted genotype-specific hrHPV persistence (adjusted OR 4.36 (95%CI: 1.18–16.04)) and ≥ HSIL was predicted by prior AIDS (adjusted OR 8.55 (95% CI 1.21–60.28)). Conclusions This prospective cohort study of well-treated WLWH in Denmark found a high rate of persistent hrHPV infections with predominantly non-16/18 hrHPV genotypes. CD4 count < 350 cells/μL predicted hrHPV persistence, while prior AIDS predicted ≥HSIL. Electronic supplementary material The online version of this article (10.1186/s12879-019-4377-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristina Thorsteinsson
- Department of Infectious Diseases, Hvidovre Hospital, Kettegaards Allé 30, 2650, Hvidovre, Denmark.
| | - Steen Ladelund
- Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Lisbeth Nilas
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Obstetrics and Gynaecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Maria Franzmann
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Hvidovre Hospital, Kettegaards Allé 30, 2650, Hvidovre, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jesper Bonde
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
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3
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Knudsen A, Thorsteinsson K, Christensen TE, Hasbak P, Ripa RS, Panum I, Lebech AM, Kjaer A. Cardiac Microvascular Dysfunction in Women Living With HIV Is Associated With Cytomegalovirus Immunoglobulin G. Open Forum Infect Dis 2018; 5:ofy205. [PMID: 30214912 PMCID: PMC6132927 DOI: 10.1093/ofid/ofy205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 09/04/2018] [Indexed: 01/09/2023] Open
Abstract
Background People living with HIV (PLWH) appear to be at increased risk of cardiovascular disease (CVD), and this is possibly more pronounced in women living with HIV (WLWH). In the general population, men are more likely to develop obstructive coronary artery disease (CAD), and women often present with a nonobstructive pattern with cardiac microvascular dysfunction. We investigated cardiac microvascular function in men and women living with HIV and tested for association with cytomegalovirus (CMV) immunoglobulin G (IgG), as this has been associated with CVD in PLWH. Methods In a cross-sectional study, 94 PLWH on antiretroviral therapy were scanned with 82Rb positron emission tomography/computed tomography at rest and during adenosine-induced stress, which enables the quantification of the myocardial flow reserve (MFR). CMV IgG was measured in plasma. Results WLWH had significantly lower MFR compared with men living with HIV (MLWH; P = .003), and >45% of the women had an MFR indicative of cardiac microvascular dysfunction, whereas this was only true for 24% of men (P = .03). CMV IgG concentrations were inversely associated with MFR among WLWH but not MLWH (P = .05 for interaction). Conclusions In this first study comparing MFR in women and men living with HIV, we found that WLWH had significantly lower MFR than MLWH and 45% of the women had cardiac microvascular dysfunction despite younger age and lower cardiovascular risk. Furthermore, CMV IgG was inversely associated with MFR among women but not men. This calls for attention to CVD among young WLWH even with low cardiovascular risk.
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Affiliation(s)
- Andreas Knudsen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Thomas E Christensen
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rasmus Sejersten Ripa
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Inge Panum
- Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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4
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Behzadi MA, Davarpanah MA, Namayandeh M, Pourabbas B, Allahyari S, Ziyaeyan M. Molecular diagnosis of genital tract infections among HIV-positive women in Iran. IRANIAN JOURNAL OF MICROBIOLOGY 2018; 10:233-241. [PMID: 30483375 PMCID: PMC6243152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Human immunodeficiency virus (HIV)-infected women are usually at a higher risk of sexually transmitted infections (STIs) than others. The objective of this study was to characterize the prevalence of human papilloma virus (HPV), herpes simplex virus (HSV), Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG), and associated risk factors among HIV-infected women in Fars province, Iran. MATERIALS AND METHODS In this cross-sectional study, cervical swab samples were collected from 71 HIV-infected women, aged 17-45 years (mean ± standard deviation: 31.11 ± 6.58 years), and tested for HPV, HSV, CT, and NG using PCR assays. RESULTS Overall, 77.5% of patients were positive for the tested STIs with the following distribution: 36 (50.7%) HPV, 7 (9.9%) HSV, 4 (5.6%) NG, and 27 (38%) CT. From those, 39 (55%) were positive for only one infection, while 16 (22.5%) were positive for multiple infections. We observed that the prevalence of all tested STIs increased by age, except for HSV which showed a slight decrease, although not statistically significant. Socio-economic factors such as low educational level, multiple sex partners, and being a sex worker significantly correlated with higher positive prevalence of STIs in the studied population. CONCLUSION A high prevalence of STIs was observed among HIV-infected women in this region. These data might prompt policy makers and STI experts to focus on providing a comprehensive sex education, including participation in screening programs for STIs among high-risk groups.
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Affiliation(s)
- Mohammad Amin Behzadi
- Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mandana Namayandeh
- Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahman Pourabbas
- Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soheyla Allahyari
- HIV Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mazyar Ziyaeyan
- Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding author: Mazyar Ziyaeyan, Ph.D, Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Tel: +98-71-36474304, Fax: +98-71-36474303,
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5
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Araya BM, Solomon AA, Gebreslasie KZ, Gudayu TW, Anteneh KT. The role of counseling on modern contraceptive utilization among HIV positive women: the case of Northwest Ethiopia. BMC WOMENS HEALTH 2018; 18:121. [PMID: 29973171 PMCID: PMC6033227 DOI: 10.1186/s12905-018-0603-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/07/2018] [Indexed: 11/23/2022]
Abstract
Background Over 90% of the children with Human Immunodeficiency Virus are infected through the mother to child transmission process according to literatures. Preventing unintended pregnancy by using contraceptive methods is crucial for reducing maternal and child mortality and morbidity. Here we set out to assess the prevalence and associated factors of modern contraceptive utilization among sexually active reproductive age women attending Anti-Retroviral Therapy clinics in Amhara Region referral hospitals in 2016. Methods An institution based cross sectional study was carried out from April to July 2016 surveying women of reproductive age attending the Anti-Retroviral Therapy clinics in the five Amhara Region referral hospitals. A pretested and semi-structured questionnaire was used to collect data. EpiInfo7 and SPSS version 20 soft wares were used for data entry and analysis, respectively. Significant associations were identified on the basis of the adjusted odds ratio, with 95% Confidence Interval, and p value ≤0.05, was taken as statistically significant. Result The proportion of women utilizing modern contraceptives was 47.7% with (95% CI: 43, 52.5%), the male condom being the most (64.2%) utilized method. The use of the contraceptive methods was most prevalent among women 15–24 years of age (AOR = 6.5, 95% CI: 2–10) and age of 25–34 (AOR = 3, 95% CI: 1.6–5.5), having an urban residence (AOR = 0.095, 95% CI: 0.03–0.28), having discussed contraceptives with partner (AOR = 7, 95% CI: 5.3–11.9), receiving counseling from health care providers (AOR = 4.8, 95% CI: 1.8–7), previous history of contraceptive utilization (AOR = 5.6, 95% CI: 2.6–8.3), and with CD4 count >500mm3/dl (AOR = 2.4, 95% CI: 1.3–4.3). Conclusion The proportion of women utilizing contraceptive has been low in Amhara Region referral hospitals. Encouraging patients to discuss about contraception with partners and repeated counseling by health care providers may strengthen contraceptive utilization.
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Affiliation(s)
- Bilen Mekonnen Araya
- School of midwifery, college of medicine and health sciences, university of Gondar, Gondar, Ethiopia.
| | - Abayneh Akililu Solomon
- School of midwifery, college of medicine and health sciences, university of Gondar, Gondar, Ethiopia
| | | | - Temesgen Worku Gudayu
- School of midwifery, college of medicine and health sciences, university of Gondar, Gondar, Ethiopia
| | - Kiber Temesgen Anteneh
- School of midwifery, college of medicine and health sciences, university of Gondar, Gondar, Ethiopia
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6
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Thorsteinsson K, Storgaard M, Katzenstein TL, Ladelund S, Rönsholt FF, Johansen IS, Pedersen G, Gaardsting A, Nielsen LN, Bonde J, Lebech AM. Prevalence of cervical, oral, and anal human papillomavirus infection in women living with HIV in Denmark - The SHADE cohort study. J Clin Virol 2018; 105:64-71. [PMID: 29906660 DOI: 10.1016/j.jcv.2018.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/20/2018] [Accepted: 05/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Women living with HIV (WLWH) have elevated risk of human papillomavirus (HPV) related cancers. OBJECTIVES To assess prevalence, distribution and concordance of cervical, oral, and anal HPV infection, and predictors of oral and anal HPV in WLWH in Denmark. STUDY DESIGN WLWH followed in the Study on HIV, cervical Abnormalities and infections in women in Denmark (SHADE) were enrolled and examined for cervical, oral, and anal HPV infection. Logistic regression models were used to identify predictors of anal and oral HPV. RESULTS A total of 214 of 334 WLWH had sufficient DNA for analysis at all three anatomical sites and were included in analyses. Cervical, oral, and anal high-risk (hr) HPV prevalence were 28.0%, 3.7% and 39.3%. Most frequent i) cervical, ii) oral and iii) anal hrHPV genotypes were i) hrHPV58 (8.4%), 52 (5.1%), 16 (5.1%) and 51 (5.1%); ii) 52 (1.4%) and iii) 51 (9.3%), 58 (8.9%), 16 (7.0%) and 18 (7.0%). Among present cervical, oral, and anal hrHPV genotypes, 6.7%, 12.5% and 17.9% were targeted by the 2-or 4-valent HPV vaccines, whereas 50.0%, 50.0% and 42.9% of hrHPV genotypes were covered by the 9-valent HPV vaccine. Anal HPV infection was predicted by cervical HPV infection (adjusted OR 4.47 (95%CI 2.25-8.89)). CONCLUSION Cervical and anal HPV infection were highly prevalent in WLWH. Non-16/18 hrHPV genotypes were predominant at all anatomical sites. Almost half of all hrHPV infections at the three anatomical sites could have been prevented by childhood/adolescent vaccination with the 9-valent HPV vaccine.
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Affiliation(s)
| | - Merete Storgaard
- Department of Infectious Diseases, Skejby, Aarhus University Hospital, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark; Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - Steen Ladelund
- Clinical Research Center, Hvidovre, Copenhagen University Hospital, Denmark
| | - Frederikke F Rönsholt
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Denmark
| | - Anne Gaardsting
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lars Nørregård Nielsen
- Department of Infectious Diseases, Nordsjællands Hospital, Copenhagen University Hospital, Denmark
| | - Jesper Bonde
- Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
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7
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Abstract
PURPOSE OF REVIEW Syphilis continues to cause morbidity and mortality worldwide. While syphilis infection is easily identifiable and treatable, rates of syphilis infection continue to increase among select populations in high-income countries and remain at endemic levels in low- and middle-income counties. RECENT FINDINGS World Health Organization recommended strategies have led to the dual elimination of mother-to-child transmission of syphilis and HIV in several countries, however outbreaks among select populations need to be adequately addressed. SUMMARY Continued vigilance and investment is needed to address syphilis worldwide. The epidemiology of syphilis differs in high-income and low- and middle-income counties.
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Affiliation(s)
- Noah Kojima
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, 90095
| | - Jeffrey D Klausner
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, 90095
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, 90024
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8
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Microbiota-Dependent Marker TMAO is Not Associated With Decreased Myocardial Perfusion in Well-Treated HIV-Infected Patients as Assessed by 82Rubidium PET/CT. J Acquir Immune Defic Syndr 2018; 72:e83-5. [PMID: 27152465 DOI: 10.1097/qai.0000000000001044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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9
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Aebi-Popp K, Mercanti V, Voide C, Nemeth J, Cusini A, Jakopp B, Nicca D, Rasi M, Bruno A, Calmy A, Martinez de Tejada B. Neglect of attention to reproductive health in women with HIV infection: contraceptive use and unintended pregnancies in the Swiss HIV Cohort Study. HIV Med 2018; 19:339-346. [PMID: 29336516 DOI: 10.1111/hiv.12582] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Women with HIV infection are mainly of reproductive age and need safe, effective and affordable contraception to avoid unintended pregnancies. The aim of this study was to evaluate contraceptive use and unintended pregnancies in this population in Switzerland. METHODS A self-report anonymous questionnaire on contraceptive methods, adherence to them, and unintended pregnancies was completed by women included in the Swiss HIV Cohort Study (SHCS) between November 2013 and June 2014. Sociodemographic characteristics and information related to combined antiretroviral therapy and HIV disease status were obtained from the SHCS database. RESULTS Of 462 women included, 164 (35.5%) reported not using any contraception. Among these, 65 (39.6%) reported being sexually active, although 29 (44.6%) were not planning a pregnancy. Of 298 women using contraception, the following methods were reported: condoms, 219 (73.5%); oral hormonal contraception, 32 (10.7%); and intrauterine devices, 28 (9.4%). Among all women on contraception, 32 (10.7%) reported using more than one contraceptive method and 48 (16%) had an unintended pregnancy while on contraception (18, condoms; 16, oral contraception; four, other methods). Of these, 68.1% terminated the pregnancy and almost half (43.7%) continued using the same contraceptive method after the event. CONCLUSIONS Family planning needs in HIV-positive women are not fully addressed because male condoms remained the predominant reported contraceptive method, with a high rate of unintended pregnancies. It is of utmost importance to provide effective contraception such as long-acting reversible contraceptives for women living with HIV.
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Affiliation(s)
- K Aebi-Popp
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - V Mercanti
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - C Voide
- Infectious Diseases Division, University Hospital Centre of the canton of Vaud, Lausanne, Switzerland
| | - J Nemeth
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zurich, Switzerland
| | - A Cusini
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - B Jakopp
- Department of Infectious Diseases, Cantonal Hospital, Aarau, Switzerland
| | - D Nicca
- Department of Nursing Science, University of Basel, Basel, Switzerland
| | - M Rasi
- Department of Infectious Diseases, Cantonal Hospital, St Gallen, Switzerland
| | - A Bruno
- Department of Infectious Diseases, Regional Hospital, Lugano, Switzerland
| | - A Calmy
- Infectious Diseases Division, Department of Internal Medicine, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - B Martinez de Tejada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
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10
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Madsen AMR, Thorsteinsson K, Lebech AM, Storgaard M, Katzenstein TL, Rönsholt FF, Johansen IS, Pedersen G, Nielsen LN, Andersen AB, Jensen JS. Prevalence and significance of Mycoplasma genitalium in women living with HIV in Denmark. BMC Res Notes 2017; 10:468. [PMID: 28882163 PMCID: PMC5590158 DOI: 10.1186/s13104-017-2776-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/31/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Mycoplasma genitalium (M. genitalium) is a sexually transmitted pathogen associated with urethritis, cervicitis, and pelvic inflammatory disease. Previous studies have shown a strong association between M. genitalium and HIV infection, therefore screening and treatment for M. genitalium has been suggested as part of HIV prevention strategies. The objective of this study was to determine the prevalence of M. genitalium in women living with HIV (WLWH) in Denmark, and to compare the result with data on symptoms from the lower abdomen, sexual habits and immune status. 234 women, recruited from Danish HIV centres as part of a larger observational study on aspects of living with HIV as a woman (the SHADE study), were included. RESULTS We tested cervical samples for M. genitalium by specific PCR. We found three samples positive (1.3%). The women were between 30 and 50 years old, all were of Asian origin, sexually active, and on antiretroviral treatment with supressed HIV RNA and CD4 count >350 cells/µL. None reported symptoms from the lower abdomen. The prevalence of M. genitalium infection in WLWH in Denmark is low, thus systematic screening for M. genitalium in this group does not seem relevant.
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Affiliation(s)
- Anne Marie Rosendahl Madsen
- Department of Clinical Microbiology, Odense University Hospital, J.B. Winsloews Vej 21, 2, 5000, Odense C, Denmark. .,Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
| | | | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederikke F Rönsholt
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | | | - Aase Bengaard Andersen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
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11
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Wessman M, Thorsteinsson K, Storgaard M, Rönsholt FF, Johansen IS, Pedersen G, Nielsen LN, Wies N, Katzenstein TL, Lebech AM. HIV disclosure and stigma among women living with HIV in Denmark. J Virus Erad 2017; 3:140-144. [PMID: 28758021 PMCID: PMC5518242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify disclosure, stigma and predictors of non-disclosure among women living with HIV in Denmark. METHODS A questionnaire study of women living with HIV in Denmark was performed. The enrolment period was from February 2013 to March 2014. Logistic regression was used to estimate predictors of non-disclosure. RESULTS A total of 234 participants were included. The majority (94%) had disclosed their HIV status to at least one person outside their healthcare environment, although 29% had disclosed to fewer than three people. Confidantes were mostly partners (96%), siblings (63%), friends (63%) and children (41%). The primary reason for non-disclosure was a feeling that it did not concern others (55%), although reactions upon disclosure were mainly positive in 53%. Predictors of non-disclosure were being of black or Asian ethnicity. Following their HIV diagnosis, 40% no longer dared to have sex, 40% felt isolated and 23% felt that others were afraid and kept a physical distance. In contrast, after disclosure 75% felt better at taking decisions about life and 50% were in closer contact with family and friends. CONCLUSION Almost one-third of participants disclosed their HIV diagnosis to fewer than three people and black or Asian ethnicity predicted non-disclosure. HIV-related stigma regarding sex and contact with others is still highly prevalent; however, reactions to disclosure were mainly positive and associated with secondary positive gains. We strongly urge healthcare professionals to initiate a dialogue regarding stigma and disclosure with women living with HIV with a view to increasing disclosure and minimising stigmatisation in this vulnerable population.
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Affiliation(s)
- Maria Wessman
- Department of Infectious Diseases,
Copenhagen University Hospital Hvidovre,
Denmark,Corresponding author: Maria Wessman,
Copenhagen University Hospital Hvidovre,
Kettegaard Alle 30,
2650Hvidovre,
Denmark
| | | | - Merete Storgaard
- Department of Infectious Diseases,
Aarhus University Hospital,
Denmark
| | | | - Isik S Johansen
- Department of Infectious Diseases,
Odense University Hospital,
Denmark
| | - Gitte Pedersen
- Department of Infectious Diseases,
Aalborg University Hospital,
Denmark
| | - Lars N Nielsen
- Department of Lung and Infectious Diseases,
Nordsjællands Hospital,
Denmark
| | - Nina Wies
- Department of Infectious Diseases,
Copenhagen University Hospital Hvidovre,
Denmark,Department of Clinical Medicine,
University of Copenhagen,
Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases,
Copenhagen University Hospital,
Denmark,Department of Clinical Medicine,
University of Copenhagen,
Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases,
Copenhagen University Hospital Hvidovre,
Denmark,Department of Clinical Medicine,
University of Copenhagen,
Denmark
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12
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Wessman M, Thorsteinsson K, Storgaard M, Rönsholt FF, Johansen IS, Pedersen G, Nielsen LN, Wies N, Katzenstein TL, Lebech AM. HIV disclosure and stigma among women living with HIV in Denmark. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30332-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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13
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Wessman M, Thorsteinsson K, Jensen JS, Storgaard M, Rönsholt FF, Johansen IS, Pedersen G, Nørregård Nielsen L, Bonde J, Katzenstein TL, Weis N, Lebech AM. Bacterial vaginosis, human papilloma virus and herpes viridae do not predict vaginal HIV RNA shedding in women living with HIV in Denmark. BMC Infect Dis 2017; 17:376. [PMID: 28569142 PMCID: PMC5452403 DOI: 10.1186/s12879-017-2477-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 05/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) has been found to be associated with HIV acquisition and transmission. This is suggested to be due to higher HIV RNA levels in cervicovaginal fluids in women living with HIV (WLWH) with BV, as bacteria associated with BV may induce viral replication and shedding in the genital tract despite undetectable HIV RNA plasma viral load. We examined the prevalence and diagnostic predictors of BV and HIV-1 RNA vaginal shedding in women living with HIV (WLWH) in Denmark, taking into account the presence of human papillomavirus (HPV) and herpes viridae. METHODS WLWH between 18-51 years were recruited from six Departments of Infectious Diseases in Denmark during enrolment in the SHADE cohort; a prospective cohort study of WLWH attending regular outpatient care. BV was diagnosed by microscopy of vaginal swabs and PCR was used for detection of BV-associated bacteria, HPV, herpes viridae, and vaginal HIV viral load. RESULTS Median age of the 150 included women was 41 years; ethnicity was predominantly White (35%) or Black (47%). The majority (96%) was on ART and had undetectable (85%) plasma HIV RNA (<40 copies/mL). BV was diagnosed in 32%. Overall, 11% had detectable vaginal HIV RNA. Both before and after adjustment for BV, age, ethnicity, plasma HIV RNA, CD4 cell count, herpes viridae and HPV, we found no significant predictors of HIV RNA vaginal shedding. CONCLUSION In well-treated WLWH, BV, herpes viridae or HPV do not predict vaginal HIV RNA shedding. This implies that HIV shedding does not seem to be increased by BV.
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Affiliation(s)
- Maria Wessman
- Department of Infectious Diseases, Copenhagen University Hospital, Kettegaard Allé 30, Hvidovre, DK-2650, Copenhagen, Denmark.
| | - Kristina Thorsteinsson
- Department of Infectious Diseases, Copenhagen University Hospital, Kettegaard Allé 30, Hvidovre, DK-2650, Copenhagen, Denmark
| | - Jørgen S Jensen
- Department of Microbiology and Infection Control, Statens Serum Institut, 2300, Copenhagen, Artillerivej 5, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Skejby, 8200, Aarhus, Denmark
| | - Frederikke F Rönsholt
- Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Søndre Boulevard 29, 5000, Odense, Denmark
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
| | - Lars Nørregård Nielsen
- Department of Lung- and Infectious Diseases, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - Jesper Bonde
- Department of Pathology, Copenhagen University Hospital, Kettegaard Allé 30, Hvidovre, -2650, Copenhagen, DK, Denmark.,Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Kettegaard Allé 30, Hvidovre, DK-2650, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Kettegaard Allé 30, Hvidovre, DK-2650, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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14
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Ørbæk M, Hasbak P, Sejersten Ripa R, Kjær A, Lebech AM, Knudsen A. Comparison of the Peripheral Reactive Hyperemia Index with Myocardial Perfusion Reserve by 82Rb PET/CT in HIV-Infected Patients. Diagnostics (Basel) 2017; 7:diagnostics7020031. [PMID: 28561781 PMCID: PMC5489951 DOI: 10.3390/diagnostics7020031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/30/2017] [Accepted: 05/26/2017] [Indexed: 01/09/2023] Open
Abstract
After the introduction of antiretroviral therapy (ART) the life expectancy of patients infected with human immunodeficiency virus (HIV) is now approaching that of the general population and the importance of non-AIDS co-morbidities is increasing. Specifically, the risk of coronary artery disease (CAD) seems to be higher in HIV-infected patients and an accurate risk prediction of CAD is of high importance for optimal long term treatment. In this study, we assessed the correlation of the endoPAT, which is an office-based CVD screening tool with the myocardial perfusion reserve by 82-rubidium PET/CT. We measured the reactive hyperemia index, which is a measure of the endothelial responsiveness, by the use of an endoPAT device (Itamar Medical, Caesarea, Israel) in 48 ART treated HIV-infected patients with high CD 4 cell counts and viral suppression (HIV-RNA < 20 copies/mL), who had previously undergone measurement of the myocardial perfusion reserve by 82-rubidium PET/CT for study purposes. We found an inverse correlation between the reactive hyperemia index and the myocardial perfusion reserve which most likely indicates different vascular physiology. This study did not find evidence to suggest the immediate implementation of the reactive hyperemia index as a screening tool for early coronary artery disease in well-treated HIV-infected patients pending further validation in larger prospective studies.
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Affiliation(s)
- Mathilde Ørbæk
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre 2650, Denmark.
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET, and Cluster for Molecular Imaging, Copenhagen University Hospital, Rigshospitalet and University of Copenhagen, Copenhagen 2100, Denmark.
| | - Rasmus Sejersten Ripa
- Department of Clinical Physiology, Nuclear Medicine & PET, and Cluster for Molecular Imaging, Copenhagen University Hospital, Rigshospitalet and University of Copenhagen, Copenhagen 2100, Denmark.
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET, and Cluster for Molecular Imaging, Copenhagen University Hospital, Rigshospitalet and University of Copenhagen, Copenhagen 2100, Denmark.
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre 2650, Denmark.
| | - Andreas Knudsen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre 2650, Denmark.
- Department of Clinical Physiology, Nuclear Medicine & PET, and Cluster for Molecular Imaging, Copenhagen University Hospital, Rigshospitalet and University of Copenhagen, Copenhagen 2100, Denmark.
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15
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Thorsteinsson K, Storgaard M, Katzenstein TL, Ladelund S, Rønsholt FF, Johansen IS, Pedersen G, Hashemi L, Nielsen LN, Nilas L, Obel N, Bonde J, Lebech AM. Prevalence and distribution of cervical high-risk human papillomavirus and cytological abnormalities in women living with HIV in Denmark - the SHADE. BMC Cancer 2016; 16:866. [PMID: 27821088 PMCID: PMC5100104 DOI: 10.1186/s12885-016-2881-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/24/2016] [Indexed: 02/07/2023] Open
Abstract
Background Women living with HIV (WLWH) are at increased risk of persistent human papillomavirus (HPV) infection, cervical dysplasia and cervical cancer compared with women from the general population (WGP). We assessed the prevalence and distribution of cervical high-risk (hr) HPV infection and cytological abnormalities in WLWH compared with WGP in Denmark. Predictors of HPV and cytological abnormalities were estimated in WLWH. Methods WLWH consecutively enrolled in the Study on HIV, cervical Abnormalities and infections in women in Denmark (SHADE) in 2011 and were examined for cervical HPV and cytological abnormalities. WLWH were matched on age and prior cytological findings with WGP from an earlier study. HIV demographics were retrieved from the nationwide Danish HIV Cohort Study. Logistic regression was used to estimate predictors of hrHPV and cytological abnormalities. Results Of 334 included WLWH 26.4 % were positive for hrHPV as opposed to 16.6 % WGP (p < 0.0001). WLWH had a higher number of multiple infections (>1 h genotype present) (38.5 % versus 25.7 %, p = 0.030). Hr genotypes in descending order of frequency were HPV58 (7.1 %), 52 (5.4 %), and 16 (4.8 %) in WLWH versus HPV16 (4.1 %), 52 (2.8 %) and 58 (2.4 %) in WGP. Predictors of hrHPV in WLWH were short duration of HAART (adjusted OR per year 0.90 (95 % CI 0.84-0.96)), AIDS prior to inclusion (adjusted OR 3.61 (95 % CI 1.75-7.46)), ≥5 lifetime sexual partners (adjusted OR 2.20 (95 % CI 1.08-4.49)), sexual debut <16 years of age (adjusted OR 2.05 (95 % CI 1.03-4.10)) and CD4 < 350 cells/μL (adjusted OR 2.53 (95 % CI 1.20-5.40)). Cytological abnormalities were prevalent in 10.4 % vs. 5.2 % (p = 0.0003) of WLWH and WGP. In WLWH with hrHPV, short duration of HAART predicted cervical dysplasia (adjusted OR per year 0.83 (95 % CI 0.71-0.97)). Conclusions WLWH presented with more cervical hrHPV infections and cytological abnormalities, and a different distribution of hrHPV genotypes compared with WGP. Cervical hrHPV and cytological abnormalities were predicted by short duration of HAART. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2881-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristina Thorsteinsson
- Department of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Infectious Diseases, Hvidovre Hospital, Kettegaards Allé 30, 2650, Hvidovre, Denmark.
| | - Merete Storgaard
- Department of Infectious Diseases, Skejby, Aarhus University Hospital, Aarhus, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steen Ladelund
- Clinical Research Center, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Lailoma Hashemi
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Lisbeth Nilas
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Obstetrics and Gynaecology, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Bonde
- Molecular Pathology Laboratory, Department of Pathology, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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