Gynecologic Issues in the HIV-Infected Woman
Section snippets
Menstrual disorders
HIV-infected women frequently report changes in their menstrual cycles [1], and early reports suggested an increase in abnormal menses in this population [2], [3]. HIV-infected women may have menstrual dysfunction for a variety of reasons that are not directly related to their disease. In the United States, women infected with HIV are disproportionately poor and have an increased frequency of illicit drug use [4], which may cause amenorrhea. One study demonstrated that low socioeconomic class
Lower genital tract neoplasias
The Centers for Disease Control and Prevention (CDC), in 1993, made invasive cervical cancer an AIDS-defining condition [17], and moderate and severe dysplasia were included on the list of conditions whose course or management may be complicated by HIV infection (category B conditions). These changes were made in response to the growing body of research in the early 1990s demonstrating that HIV-infected women have an increased prevalence of cervical dysplasia [40], [41], [42], [43], although a
Contraception
In the HIV-seropositive woman, contraception must play the dual role of birth control and prevention of transmission of HIV and other sexually transmitted infections. The clinician must carefully consider if a contraceptive option is effective, will prevent HIV transmission, will interact with other medications the patient is taking, or will affect the HIV infection itself. Although there is a high correlation between HIV-RNA levels in the blood and HIV in cervico-vaginal secretions, the
Surgical complications
Women with HIV may be at risk for an increase in gynecologic surgery for a number of reasons. One longitudinal cohort study reported that women living with HIV are more likely than seronegative controls to have a hysterectomy, and that this was most often done for cervical neoplasia [171]. Other studies demonstrated a trend toward more tuboovarian abscesses, which often require surgical intervention, among women with pelvic inflammatory disease who were HIV infected [172], [173]. There is a
Osteopenia and osteoporosis
Because of the improved prognosis, and because 5% to 10% of new HIV infections in the United States are currently in people older than 50, the population of seropositive people is aging. Disorders of bone mineral density appear to be more frequently seen in people living with HIV, and so the clinician caring for seropositive women needs to pay special attention to assessing and modifying their patients' risk factors for osteoporosis as well as screening for and treating it.
Initially the
Fertility
As the population of HIV-infected individuals in this country has shifted from primarily gay and bisexual men to heterosexuals of childbearing age, the number of seropositive women contemplating pregnancy has drastically increased. Referrals to gynecologists caring for HIV-infected women are sometimes made by infectious disease specialists caring for men who, with their partners, plan to start a family. In a survey of 2864 HIV-seropositive adults, almost one third expressed a desire to have
Sexually transmitted infections
The treatment of most sexually transmitted infections is similar in HIV-infected and noninfected women [220]. Only differences in treatment will be discussed here.
Herpes simplex virus-2 infections affect 50% to 90% of HIV-infected individuals worldwide [221]. The CDC in 1993 added a herpetic lesion present for at least 1 month's duration to the list of AIDS-defining illnesses [17]. HIV-infected women tend to have more herpes simplex virus (HSV) infections of increased severity, with an
Summary
We have made great strides in understanding the management of the many gynecologic conditions that affect HIV-positive women with an increased frequency. As the HIV-infected woman's life expectancy continues to lengthen, we will need new treatments for recurring conditions such as lower genital tract neoplasias. We have much to learn about the interaction between sex steroids, HIV infection, and the immune system. As our knowledge grows, we will be better equipped to counsel women about
References (238)
Hemostatic abnormalities in HIV diseases
Hematol Oncol Clin North Am
(1991)- et al.
Pathophysiology and management of HIV-associated hematologic disorders
Blood
(1989) - et al.
Hyperinsulinemia induced by highly active antiretroviral therapy in an adolescent with polycystic ovary syndrome who was infected with human immunodeficiency virus
Fertil Steril
(2003) - et al.
Characteristics of menstruation in women infected with HIV
Obstet Gynecol
(1996) - et al.
Biologic markers of ovarian reserve and reproductive aging: application in a cohort study of HIV infection in women
Fertil Steril
(2007) - et al.
High risk of HPV infection and cervical squamous intraepithelial lesions among women with symptomatic HIV infection
Am J Obstet Gynecol
(1991) - et al.
Papanicolaou smear abnormalities in ambulatory care sites for women infected with HIV
Am J Obstet Gynecol
(1992) - et al.
HPV, HIV infection, and risk of cervical intraepithelial neoplasias in former intravenous drug abusers
Gynecol Oncol
(1993) - et al.
HPV infections and immunosuppression
Clin Dermatol
(1997) - et al.
Human papillomavirus infection in HIV-seropositive women
Obstet Gynecol
(1995)
The prevalence and incidence of gynecologic disease among HIV infected and uninfected women
Am J Obstet Gynecol
Human papillomavirus-associated cervical cytology abnormalities among women with or at risk of infection with HIV
Am J Obstet Gynecol
The increased frequency of cervical dysplasia-neoplasia in women infected with the HIV is related to the degree of immunosuppression
Am J Obstet Gynecol
Prevalence, risk factors, and accuracy of cytologic screening for cervical intraepithelial neoplasias in women with the HIV
Gynecol Oncol
The HIV-1 tat protein enhances E2-dependent human papillomavirus transmission
Virus Res
Langerhans' cell counts and cervical intraepithelial neoplasias in women with HIV infection
Gynecol Oncol
Characterization of genital HPV infection in women who have or who are at risk of having HIV infection
Am J Obstet Gynecol
Depletion of stromal and intraepithelial antigen-presenting cells in cervical neoplasias in HIV infection
Hum Pathol
Lymphoid follicles are generated in high-grade cervical dysplasia and have differing characteristics depending on HIV status
Am J Pathol
Characteristics of cervical intraepithelial neoplasia in women infected with the human immunodeficiency virus
Am J Obstet Gynecol
The value of cervical cytology in HIV-infected women
Gynecol Oncol
Cost effectiveness of HPV testing to augment cervical cancer screening in women infected with the HIV
Am J Med
Cervical and anal HPV infections in HIV positive women and men
Virus Res
HIV-positive women report hormone problem
WORLD Newsletter
Secondary amenorrhea: prevalence and medical contract—A cross-sectional study from a Danish county
Br J Obstet Gynaecol
Identification of psychobiological stressors among HIV-positive women. HIV Neurobehavioral Research Center (HNRC) Group
Women Health
Amenorrhea in an HIV-infected woman
AIDS Read
Menstrual function and renal transplantation
Obstet Gynecol
Sex hormones in amenorrheic women with alcoholic liver disease
J Clin Endocrinol Metab
Weight loss and wasting remain common complications in individuals infected with HIV in the era of highly active antiretroviral therapy
Clin Infect Dis
Body composition and endocrine function in women with AIDS wasting
J Clin Endocrinol Metab
Menstrual function in HIV-infected women without AIDS
J Acquir Immune Defic Syndr
Centers for Disease Control and Prevention: 1993 Revised classification for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults
Morbidity and Mortality Weekly Report (MMWR), Recommendation and Reports
Menstrual symptoms in women infected by the HIV
Obstet Gynecol
Effect of HIV infection on menstrual cycle length
J Acquir Immune Defic Syndr
Comparison of gynecologic history and laboratory results in HIV-positive women with CD4+ lymphocyte counts between 200 and 500 cells/μl and below 100 cells/μl
J Acquir Immune Defic Syndr
Endocrine function in 98 HIV-infected patients: a prospective study
J Acquir Immune Defic Syndr
Serum hormones in men with HIV-associated wasting
J Clin Endocrinol Metab
Metabolic disturbances and wasting in the acquired immunodeficiency syndrome
N Engl J Med
The use of a sensitive equilibrium dialysis method for the measurement of free testosterone levels in healthy, cycling women and in HIV-infected women
J Clin Endocrinol Metab
Testosterone deficiency in women: etiologies, diagnosis, and emerging treatments
Int J Fertil
Ultrasonographical and hormonal description of the normal ovulatory menstrual cycle
Acta Obstet Gynecol Scand
Use of urine biomarkers to evaluate menstrual function in healthy premenopausal women
Am J Epidemiol
Frequency of anovulation and early menopause among women enrolled in selected adult AIDS clinical trials group studies
J Infect Dis
Impact of the ovulatory cycle on virologic and immunologic markers in HIV-infected women
J Infect Dis
Hormonal levels among HIV-1-seropositive women compared with high-risk HIV-seronegative women during the menstrual cycle. Women's Health Study (WHS) 001 and WHS 001a Study Team
J Womens Health Gend Based Med
Cited by (24)
Deficits in bone strength, density and microarchitecture in women living with HIV: A cross-sectional HR-pQCT study
2020, BoneCitation Excerpt :Reproductive history included age at menarche, number of live births, history of menstrual cycle disturbance not due to surgery, breastfeeding, pregnancy or hormonal contraception (oligomenorrhea – cycle lengths longer than 35 days up to 6 months; amenorrhea – less than 12 months but more than 6 months without flow; prolonged amenorrhea – 12 months or longer without flow), hysterectomy and ovariectomy surgeries and history of hormonal therapy. Reproductive status was classified as follows: premenopause/perimenopause, if women reported spontaneous menses in the past year (when not on hormonal contraception or menopausal-type hormone therapy) or age < 55 y and underwent a hysterectomy without oophorectomy or with unilateral oophorectomy; natural menopause if women were ≥ 55 y and reported >1 year without menses, or if women < 55 y reported >1 y without menses and had a plasma follicle stimulating hormone (FSH) level of ≥25 IU/L [19]; and, surgical menopause if bilateral oophorectomy. Falls in the past month and past fracture history were also recorded, by fracture site and type.
Consensus Statement by GeSIDA/National AIDS Plan Secretariat on antiretroviral treatment in adults infected by the human immunodeficiency virus (Updated January 2013)
2013, Enfermedades Infecciosas y Microbiologia ClinicaSusceptibility to cervical cancer: An overview
2012, Gynecologic OncologyCitation Excerpt :A relationship between Human immunodeficiency virus (HIV) infection and invasive cervical cancer was established in several studies. The HIV positive patients are susceptible to cervical cancer and cervical intraepithelial neoplasia due to the HIV induced immunosuppression, and both HIV and HPV interact synergically [87]. Thus, multiple infections with HR-HPV as well as infection with other agents, such as HIV and CT, seem to play a critical role in furthering the progression to cervical intraepithelial neoplasia and cervical cancer.
Consensus document of Gesida and Spanish Secretariat for the National Plan on AIDS (SPNS) regarding combined antiretroviral treatment in adults infected by the human immunodeficiency virus (January 2012)
2012, Enfermedades Infecciosas y Microbiologia ClinicaHIV infection and contraception
2011, Journal of the Association of Nurses in AIDS CareCitation Excerpt :For example, protease inhibitors (PIs: such as lopinavir and ritonavir) and non-nucleoside reverse transcriptase inhibitors (such as nevaripine) are metabolized by the CYP3A4 liver enzyme system. The effect of these drugs on liver enzymes can lead to changes in the contraceptive steroid levels, which could interfere with the overall efficacy of oral contraception (Cejtin, 2008). PIs in particular and non-nucleoside reverse transcriptase inhibitors have been found to decrease the ethinylestradiol and progesterone concentrations, whereas nucleoside reverse transcriptase inhibitors seem to have no pharmacokinetic interactions with the ethinylestradiol-progesterone levels (Cejtin, 2008).
National Consensus Document by GESIDA/National Aids Plan on Antiretroviral Treatment in Adults Infected by the Human Immunodeficiency Virus (January 2011 Update)
2011, Enfermedades Infecciosas y Microbiologia Clinica
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