Management Of HIV-positive Women Research Articles

Screening for cervical carcinoma in HIV-infected women: Analysis of main risk factors for cervical cytologic abnormalities.

The aim of this study was to identify potential predictive factors for cervical disease in women with HIV and to evaluate adherence during follow-up to cervical cancer screening. In order to identify the independent role of factors associated with the presence of a cervical abnormality, all of the variables showing in univariate analyses a potential association with the outcome variable (presence of cervical abnormalities) were entered into a multivariate logistic regression model, along with age at first visit to our center, and age at diagnosis. A total of 540 HIV-positive women who received screening for cervical cancer during the first year after their first visit to our center were included in the analysis; 423 (78.3%) had normal cytology and 117 (21.7%) had cytological abnormalities, classified as follows: 21 atypical squamous cells of undetermined significance (17.9%); 51 low-grade squamous intraepithelial lesions (43.6%); 41 high-grade squamous intraepithelial lesions (35.0%); and four cervical cancers (3.4%). In our study, women with more than two previous pregnancies were significantly associated with a lower risk of cervical cytological abnormalities compared to the other women. Women with CD4+ levels of 200-499/mm3 had a higher risk of developing cervical cytological abnormalities compared to those with a CD4+ level>500/ mm3 . In summary, management of HIV-positive women must be modeled on HIV-clinical status, CD4+ cell count, drug regimen, and adherence to follow-up, relying on the cooperation of highly qualified professionals. In HIV-positive women, an adequate screening and follow-up allows for a reduced occurrence of advanced cervical disease and prevents recourse to invalidating surgical interventions.

HIV control in postpartum mothers: a turbulent time

We conducted an audit looking at the management of HIV-positive women in the postpartum period. We found that of the women with a previous AIDS-defining condition or a CD4 count <350 cells/µL, 83% were correctly continued on antiretroviral therapy (ART) and 84.1% of these had good virological control. ART was correctly stopped in 100% of women who had always had a CD4 count >500 cells/µL. A significant finding from our audit was that all of the women who had poor virological control or stopped ART against medical advice had social issues or self-reported depression. The main recommendation was to extend the pregnancy multidisciplinary team (MDT) meeting to include the 12-month postpartum period to offer support to women to try to improve treatment outcomes.

HIV control in post-partum mothers; a turbulent time

We conducted an audit looking at the management of HIV positive women in the postpartum period. We found that of the women with a previous AIDS defining condition or a CD4 count 500 cells/µL. A significant finding from our audit was that all of the women who had poor virological control or stopped ART against medical advice had social issues or self-reported depression. The main recommendation was to extend the pregnancy multidisciplinary team (MDT) meeting to include the 12-month postpartum period to offer support to women to try to improve treatment outcomes.

Normalising childbirth in women living with HIV: a London teaching hospital experience

IntroductionOver the past 15 years there has been a significant reduction in the incidence of HIV-1 mother-to-child-transmission (MTCT) despite increasing prevalence of diagnosed HIV-1 infection during pregnancy across England and...

Atypical squamous cells, cannot exclude high grade squamous intraepithelial (ASC-H) in HIV-positive women

Objective:South Africa has very high rates of both HIV infection and cervical pathology. The management of ASC-H is colposcopy and directed biopsy, but with so many women diagnosed with HSIL and a dearth of colposcopy centres in South Africa, women with cytologic diagnosis of ASC-H may not be prioritized for colposcopy. The aim of this study was to determine if HIV-positive women with a cytologic diagnosis of ASC-H should undergo immediate colposcopy or whether colposcopy can be delayed, within the context of an underfunded health care setting with so many competing health needs.Materials and Methods:A computer database search was performed from the archives of an NGO-administered clinic that offers comprehensive HIV care. All women with a cytologic diagnosis of ASC-H on cervical smears from September 2005 until August 2009 were identified. Histologic follow up was sought in all patients.Results:A total of 2111 cervical smears were performed and 41 diagnosed as ASC-H (1.94%). No histologic follow up data was available in 15 cases. Follow up histologic results were as follows: three negative (11.5%), five koilocytosis and/ or CIN1 (19.2%), ten CIN2 (38.5%) and eight CIN3 (30.8%). There were no cases of invasive carcinoma on follow up.Conclusion:The current appropriate management of HIV-positive women in low-resource settings with a diagnosis of ASC-H on cervical smear is colposcopy, despite the costs involved. In the future and if cost-effective in developing nations, use of novel markers may help select which HIV-positive women can be managed conservatively and which ones referred for more active treatment. More research in this regard is warranted.

Ten years' experience of HIV positive pregnancies at the RVI, Newcastle Upon Tyne

IntroductionThe management of HIV positive women in pregnancy aims to reduce the risk of transmission to the baby without compromising maternal and neonatal health. Antenatal screening for HIV was introduced...