Treatment Of HIV-positive Women Research Articles

Barriers to receipt of intended treatment for HIV positive women with cervical cancer

Objective: The aim of this study is to describe limitations in completing intended treatment in HIV-positive women with cervical cancer treated at an urban hospital in the United States and to compare these limitations to those for HIV-negative women.

Reduced fecundity in HIV-positive women.

Is HIV associated with increased time to pregnancy (TTP)? HIV-positive women who discontinue a contraceptive method to become pregnant have increased TTP, particularly among those who likely do not know their status. HIV-positive women have fewer children on average than their HIV-negative counterparts due to both behavioral and biological factors. There is a need to better describe and quantify fecundity patterns associated with HIV in the general population. This cross-sectional study was based on data from 12 Demographic and Health Surveys (DHSs) conducted between 2003 and 2013 in 11 African countries. All studies collected dried blood spot samples for HIV testing and included a retrospective calendar module that recorded women's monthly reproductive status in the 5 years preceding the survey. TTP was measured among 3181 women discontinuing a contraceptive method within 2 years of the survey in order to become pregnant. We use Cox proportional hazard models for discrete survival data to model TTP and estimate fecundability odds ratios (FOR) and 95% CIs for the 12-month period following contraceptive discontinuation. In addition to employing a binary measure of HIV status, we also develop an additional explanatory measure that combines HIV status with information on whether respondents had ever been tested for HIV and received their results (which proxies for knowledge of HIV status) to reduce the threat of confounding from behavioral changes following an HIV diagnosis. In our sample, 10.3% of women were HIV-positive, and a little more than half (51.8%) of women received test results and likely knew their status. Over a 12-month observation period, HIV-positive women had a 25% average reduction in fecundity compared to HIV-negative women [adjusted FOR (aFOR) = 0.75 (0.62-0.92)] after adjusting for confounders. The 12-month fecundity patterns differed by women's likely knowledge of their status such that results were primarily driven by HIV-positive women who likely did not know their status. Moreover, reductions in fecundity attributable to HIV were not uniform over time. Among women who were still trying for pregnancy after 3 unsuccessful months, HIV-positive women had half the odds of becoming pregnant compared to HIV-negative women [aFOR = 0.50 (0.35-0.71)]. Conversely, there were no significant differences in FORs between HIV-negative and HIV-positive women in the first 3 months. Because dried blood spot samples for HIV testing were collected at the time of the survey but reproductive calendar data were collected retrospectively, it is possible that we introduced misclassification bias, as we have no knowledge if the acquisition of HIV occurred before or after pregnancy attempt. As life expectancy and quality health status improve due to earlier initiation of antiretroviral (ARV) treatment in HIV-positive women, there has been growing awareness that services should also address the fertility desires of HIV-positive women who want children. These findings indicate that if a pregnancy does not occur after 3 months of attempting pregnancy, HIV-positive women and HIV-discordant couples should request access to HIV and reproductive pre-pregnancy counseling and health assessments. A.G. was supported by the National Institutes of Health (contract T32-HD007275) during the study. During the conceptualization, data collection and analysis time frame, S.vdP. was supported by WHO/RHR/HRP Special Program in Reproductive Health and Research, Geneva, Switzerland, and HRP (the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction). The authors have no conflicts of interest to declare.

Cost-effectiveness analysis of annual Trichomonas vaginalis screening and treatment in HIV-positive women to prevent HIV transmission.

Because of a high incidence of Trichomonas infection among HIV-positive women, annual screening and treatment are recommended. Trichomonas infection is associated with a 2-fold risk of HIV transmission. The objective of this study was to determine if annual screening is cost-effective for the prevention of new HIV cases in susceptible male partners secondary to Trichomonas infection in HIV-positive women. A decision tree analysis was constructed to model the costs of Trichomonas screening, treatment, and follow-up. 200 women cycled through the model for a period of 12 months. One hundred women were unscreened and 100 were screened and treated per recommendations. Annual Trichomonas screening and treatment saves US $553 (US $475- US $645) per woman in the prevention of HIV transmission to male partners. The cost-effectiveness of this strategy was maintained across all assumptions in a sensitivity analysis. Trichomonas screening and treatment for the purpose of decreasing new HIV infections is not only cost-effective but also cost saving in HIV-positive women. If Centers for Disease Control and Prevention treatment guidelines were followed in all HIV-positive women living in the United States, the lifetime cost of new HIV infections prevented would approximate US $159,264,000 and could potentially prevent new HIV cases secondary to female-to-male transmissions.

Recurrent cervical intraepithelial neoplasia in human immunodeficiency virus-seropositive women

To determine the effect of human immunodeficiency virus (HIV) infection on the rate of recurrence of cervical intraepithelial neoplasia (CIN) after standard ablative therapy, and to correlate the degree of immunosuppression with treatment results.The clinical courses of 44 HIV-positive women with CIN were compared with those of 125 HIV-negative women. Patients were treated with cryotherapy, laser therapy, or cone biopsy per standard indications and were followed with cytology at regular intervals, with a range of follow-up of 3-43 months.Seventeen of 44 HIV-positive women (39%) developed biopsy-proven recurrent CIN, compared to 11 of 125 HIV-negative women (9%) (P < .01). The distributions of CIN severity, lesion size, and modality of treatment were similar in the two groups. In HIV-negative patients, recurrent CIN was associated with increasing grade, but in HIV-positive patients, recurrence was related to increasing immunosuppression. The mean CD4 count in HIV-positive patients with recurrence was 239/mm3, compared to 367/mm3 in HIV-positive patients who remained free of CIN. Only 18% of HIV-positive patients with CD4 counts over 500/mm3 had recurrence, compared to 45% of those with CD4 counts under 500. There was a trend toward poorer treatment results with the use of cryotherapy in HIV-positive patients. All recurrences occurred in patients whose mode of acquisition of HIV was heterosexual transmission.Recurrence rates of CIN after standard treatment in HIV-positive women are high, and recurrence is related to immune status in this high-risk group. Therapeutic strategies that address these treatment failures should be developed for HIV-seropositive women.

20. HIV infection in obstetric and gynaecological practice

The initial impact of HIV infection on the practising obstetrician and gynaecologist was specifically related to the treatment of HIV positive women who were pregnant. The current North American experience suggests that HIV will be an important consideration in gynaecology from now on.

Antiviral Therapy in Pregnancy

Though the reported experience with zidovudine in human pregnancies is very limited, it would seem unreasonable at this time to withhold zidovudine therapy for fetal considerations in the treatment of pregnant women with AIDS and ARC. Whether the treatment of HIV-positive women with zidovudine at any time during pregnancy reduces the risk of perinatal transmission is unknown. Therefore, the use of zidovudine for that indication should await the results of controlled trials. At present, if zidovudine therapy is required during pregnancy, the standard dosage of 200 mg every 4 hours should be used. The woman and her fetus should be monitored carefully for signs of toxicity.