Menstrual abnormalities more common in HIV-infected women – report
A recent study showed where menstrual abnormalities were more common in HIV-infected women, particularly those with lower CD4 cell counts or a low body weight.
Menstrual abnormalities, however, improved with the use of potent antiretroviral (ARV) drugs.
The findings were presented as a poster at the Fourth International AIDS Conference (IAS) on HIV Pathogenesis, Treatment and Prevention held recently in Sydney, Australia, and discussed in a poster discussion session on women and HIV. Dr Oliver Ezechi, of the Nigerian Institute of Medical Research, who presented the study, told delegates that some HIV physicians in Nigeria had noticed that there was considerable diversity in menstrual function amongst their HIV-positive patients.
Some women with high CD4 cell counts of 500 and above had been observed to have menstrual problems such as irregular periods or heavy bleeding, whereas other women with lower CD4 cell counts below 200, were being seen with normal menstruation.
Investigators, therefore, designed a cross-sectional study involving HIV-positive and HIV-negative women to determine if HIV did indeed affect menstrual function, and to see if they could establish the factors associated with irregular periods in women with HIV.
A total of 627 HIV-positive women and 651 HIV-negative women, recruited from an HIV testing clinic, were included in the investigators’ analyses. All were between 18 and 40 years of age. None had taken a hormonal contraceptive in the previous six months, and women with illnesses other than HIV that can affect menstruation were excluded from the study.
Overall, menstrual irregularities of any kind were much more common (28.4 per cent) in HIV-positive women than in HIV-negative (14.8 per cent). The investigators then conducted further analyses to see if women with HIV were more likely to have particular types of menstrual problems.
They found that there were no significant differences between HIV-positive and HIV-negative women for the following types of menstrual problem: bleeding between periods (intermenstrual bleeding), abnormally heavy (menorrhagia) or light (hypomenorrhoea) bleeding, and bleeding after intercourse.
However, the following types of dysfunction were significantly more common in HIV-positive women: amenorrhoea (complete lack of menstruation), oligomenorrhoea (infrequent/very light), and irregular periods and dysmenorrhoea (excessively painful periods) depended on type.
The investigators then looked to see if there were any risk factors for menstrual problems in HIV-positive women. Menstrual dysfunctions were more common in those with CD4 cell counts below 200, those with a low body mass index (BMI), and amongst HIV-positive women who were not taking antiretroviral therapy.
Ezechi said that women with HIV did, therefore, have a higher risk of menstrual dysfunction than HIV-negative women. He added that HIV-positive women with menstrual problems would benefit from the treatment of opportunistic infections, interventions to encourage weight gain, and the initiation of potent antiretroviral therapy.
