A study of women of menstrual age in Nigeria has found that menstrual abnormalities were more common in women with HIV, particularly in those with lower CD4 cell counts or a low body weight. Menstrual abnormalities improved with use of potent anti-HIV therapy. The findings were presented as a poster at the Fourth IAS Conference on HIV Pathogenesis, Treatment and Prevention in Sydney on July 23rd and discussed in a poster discussion session on women and HIV.
There are conflicting data on the influence of HIV on menstrual function – some studies have found that HIV infection adversely affects menstruation, although other studies have yielded conflicting data.
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 (500 cells/mm3 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 cells/mm3) 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 (seen at two HIV treatment centres in Nigeria) 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%) in HIV-positive women than in HIV-negative (14.8%). 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 was 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 (p
The investigators then looked to see if there were any risk factors for menstrual problems in HIV-positive women. Menstrual dysfunctions (after controlling for confounding variables) were more common in those with CD4 cell counts below 200 cells/mm3 (OR: 3.65; CI: 1.18 - 6.7; those with a body mass index (BMI) below 19.5 (OR: 2.1; CI: 1.2 - 3.2); and amongst HIV-positive women who were not taking antiretroviral therapy (OR: 1.9; CI: 1.47 - 7.7).
Dr Ezechi concluded 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.
Ezechi OC et al. Effect of HIV-1 infection and increasing immunosuppression on menstrual function. Fourth IAS Conference on HIV Pathogenesis, Treatment and Prevention, Sydney, abstract MOPDB02, 2007.