Download Section 4: Gynecological Manifestations of HIV Infection

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Document related concepts
no text concepts found
Transcript
Originally developed by:
Health Care Education &
Training, Inc.
HIV Screening and Women’s Health
Section 4:
Gynecological Manifestations of
HIV Infection
2007 Contributors from AETC Women’s
Health and Wellness Workgroup:
 Joyce Alley, RN; Health Care Education and Training, Inc.
 Laura Armas, MD; Texas/Oklahoma AETC
 Andrea Norberg, MS, RN; AETC National Resource
Center
 Tonia Poteat, MPH, MMSc, PA-C; Southeast ATEC
(SEATEC)
 Barbara Schechtman, MPH; Midwest ATEC (MATEC)
 Karen Sherman, MA; Health Care Education and Training,
Inc.
 Jamie Steiger, MPH; AETC National Resource Center
The original curriculum was developed in 2002 by MATEC and
Health Care Education & Training, Inc.
2
HIV Screening and Women’s Health
Objective for Section 4:
1. Discuss gynecological problems that indicate a
need for HIV screening, including:






3
Vaginal discharge/irritation
Abnormal uterine bleeding/amenorrhea
Abnormal Pap smear
Genital warts
Genital ulcers
Pelvic/abdominal pain and Pelvic Inflammatory
Disease (PID)
HIV Screening and Women’s Health
Co-Occurrence of HIV and Gynecologic Disorders
Women with gynecologic disorder(s) at enrollment
41%
59%
(Minkoff et al., 1999)
4
HIV Screening and Women’s Health




Anogenital warts
Syphilis
Amenorrhea
Symptomatic
candidiasis
 Oncogenic HPV
 Abnormal Pap smear
CDC HIV/AIDS Classification System:
GYN Manifestations
A
Asymptomatic
B
HIV-related
symptoms
C
AIDS-defining
conditions
1.
>500 mm3
(> 29%)
 Recurrent Vaginitis
 Cervical Cancer,
invasive
Genital Tract TB
2.
200-499 mm3
(14-28%)
 Cervical Dysplasia
Cervical Carcinoma
in situ
 Genital Tract
Lymphoma
CMV Endometritis
3.
<200 mm3
(<14%)
5
HIV Screening and Women’s Health
Vaginal Discharge/Irritation




6
Women with frequent and/or persistent vaginal
discharge should be offered an HIV test
STIs indicate HIV risk behavior and an
increased risk for HIV acquisition
Bacterial Vaginosis can increase a woman’s risk
of acquiring HIV
Yeast infections are common among women
with HIV; therefore, frequent and persistent
yeast infections are a cue for HIV testing
HIV Screening and Women’s Health
Recurrent Yeast Vaginitis as a Common
Presenting Symptom of HIV
 Prevalence of candiasis
among HIV positive women is
3-15%
 HIV positive women with
CD4 cell counts <200 have
significantly increased odds of
vaginal or oral colonization of
Candida
Credit: Jean R. Anderson, MD
7
 Recurrent yeast vaginitis is
the most common
presenting symptom of HIV
infection
HIV Screening and Women’s Health
Abnormal Uterine Bleeding
 Abnormal uterine bleeding/menstrual disorders
are very common among HIV positive women
 Bleeding may not be due to HIV disease, but
possibly to related factors such as:




8
Weight loss
Chronic disease
Substance abuse
Use of progesterone (for appetite stimulation or
contraception)
HIV Screening and Women’s Health
Abnormal Pap Smear
 30-60% of Pap smears from HIV positive women
have cytological abnormalities (Larkin et al.,
1999)
 15-40% of these Pap smears exhibit dysplasia
(Larkin et al., 1999)
 Women with HIV are more likely to have
persistence of HPV and cervical dysplasia
9
HIV Screening and Women’s Health
Abnormal Pap Smears in HIV Positive
Women
Genital Tract Neoplasia
Pap Smear Screening - WIHS Cohort
followed for 3.5 years
Benign
Ascus
LGSIL
HGSIL
Cancer
10
Cumulative Risk
HIV +
HIV 33%
67%
28%
23%
34%
8%
5%
3%
0.4%
0%
HIV Screening and Women’s Health
Cervical Neoplasia
 Cervical cancer is an AIDS defining illness
 In a study of 2,015 HIV-infected women and 577
seronegative controls, 58% of HIV- infected
women had HPV as compared with the
seronegative controls of 26%
 In HIV positive women, dysplasia is associated
with more extensive cervical involvement and is
more likely to involve other sites in the lower
genital tract
11
HIV Screening and Women’s Health
HPV as a Common Presenting Symptom of HIV
Before Treatment
After Treatment
Credit: Cliggott Publishing
Credit: Cliggott Publishing
12
HIV Screening and Women’s Health
Genital Ulcers
 Diseases which present with genital ulcers and may be
associated with HIV disease include: herpes, syphilis,
chancroid, cytomegalovirus, lymphogranuloma
venereum, granuloma inguinale, and tuberculosis
 Women with HIV often experience more severe
manifestations of these diseases due to
immunosuppression
 Genital ulcers serve as a portal of entry for HIV; thus
women affected by such ulcers are at a greater risk of
infection
13
HIV Screening and Women’s Health
Pelvic/Abdominal Pain
 Pelvic inflammatory disease (PID) or pregnancy
are common causes of pelvic pain
 Many studies have shown an increased
prevalence of HIV in hospitalized PID patients,
indicating that providers should offer women with
PID an HIV test
 All pregnant women should be offered an HIV
test, as part of routine prenatal care
14
HIV Screening and Women’s Health
Resources
 AIDS Education and Training Centers
www.aidsetc.org
 Cervical Cancer Screening and the HIV-Infected Woman slide set
 Human Papillomavirus and the HIV-Infected Woman slide set
 Common Sexually Transmitted Diseases and the HIV-Infected
Woman slide set
 Title X Family Planning Regional Training Centers
http://opa.osophs.dhhs.gov/titlex/ofp-training-granteeslisting.html
 Health Resources and Services Administration, HIV/AIDS
Bureau
http://hab.hrsa.gov/publications/womencare05/index.htm
 A Guide to the Clinical Care of Women with HIV, 2005 edition, Ed.
Jean R. Anderson
15
HIV Screening and Women’s Health
References
Ahdieh, L., Klein, R.S., Burk, R., Cu-Uvin, S., Schuman, P., Duerr, A., Safaeian, M., Astemburski, J.,
Daniel, R., & Shah, K. (2001). Prevalence, incidence, and type-specific persistence of human
papillomavirus in human immunodeficiency virus (HIV)-positive and HIV-negative women.
Journal of Infectious Diseases, 184: 682–690.
Ahdieh, L., Munoz, A., Vlahov, D., Trimble, C., Timpson, L., & Shah, K. (2000). Cervical neoplasia
and repeated positivity of human papillomavirus infection in human immunodeficiency virusseropositive and -seronegative women. American Journal of Epidemiology, 151: 1148–1157.
American Society For Colposcopy and Cervical Pathology. Consensus Guidelines. Retrieved on
August 6, 2007 from http://www.asccp.org/
Anderson, J.R., ed. (2005). A Guide to the Clinical Care of Women with HIV. Health Resources and
Services Administration HIV/AIDS Bureau.
Branca, M., Garbuglia, A.R., Benedetto, A., Cappiello, T., Leoncini, L., Migliore, G., Agarossi, A., &
Syrjanen, K. (2003). Factors predicting the persistence of genital human papillomavirus
infections and Pap smear abnormality in HIV-positive and HIV-negative women during
prospective follow-up. International Journal of STDs & AIDS, 14: 417–425.
Centers for Disease Control and Prevention. 1993 Revised Classification System for HIV Infection
and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults. MMWR,
December 18, 1992, 41 (RR-17).
Centers for Disease Control and Prevention. (2004). Bacterial Vaginosis Fact Sheet. Retrieved on
August 6, 2007 from http://www.cdc.gov/std/bv/STDFact-Bacterial-Vaginosis.htm
Centers for Disease Control and Prevention. Sexually Transmitted Diseases Guidelines 2006.
Retrieved on August 6, 2007 from http://www.cdc.gov/std/treatment/
16
HIV Screening and Women’s Health
References (continued)
Evander, M., Edlund, K., Gustafsson, A., Jonsson, M., Karlsson, R., Rylander, E., & Wadell, G.
(1995) Human papillomavirus infection is transient in young women: a population-based cohort
study. Journal of Infectious Diseases, 171: 1026–1030.
Feingold A.R., Vermund, S.H., Burk, R.D., Kelley, K.F., Schrager, L.K., Schreiber, K., Munk, G.,
Friedland, G.H., & Klein, R.S. (1990). Cervical cytologic abnormalities and papillomavirus in
women infected with human immunodeficiency virus. Journal of Acquired Immune Deficiency
Syndromes. 3(9): 896-903.
Garcia, P.M. & Sha, B.E. (2000) Women and HIV: Continuing the Challenge. Retrieved on August 6,
2007 from http://www.medscape.com/viewprogram/621
Grulich, A.E., Li, Y., Correll, P., McDonald, A., & Kaldor, J.M. (2000) National linkage of HIV, AIDS and
cancer incidence data. 4th International AIDS Malignancy Conference. Journal of Acquired
Immune Deficiency Syndromes, 23: A15 (abstract 1).
Heard, I., Tassie, J.M., Schmitz, V., Mandelbrot, L., Kazatchkine, M.D., & Orth, G. (2000). Increased
risk of cervical disease among human immuodeficiency virus-infected women with severe
immunosuppression and high human papillomavirus load. Obstetrics & Gynecology, 96: 403–
409.
Hillemanns, P., Ellerbrock, T.V., McPhillips, S., Dole, P., Alperstein, S., Johnson, D., Sun, X.W.,
Chiasson, M.A., & Wright, T.C. (1996). Prevalence of anal cytologic abnormalities and anal
human papillomavirus infections in HIV-seropositive women. AIDS, 10: 1641–1647.
Ho, G.H., Bierman, R., Beardsley, L., Chang, C.J., & Burk, R.D. (1998). Natural history of
cervicovaginal papillomavirus infection in young women. New England Journal of Medicine,
338: 423–428.
Holly, E.A., Ralston, M.L., Darragh, T.M., Greenblatt, R.M., Jay, N., & Palefsky, J.M. (2001).
Prevalence and risk factors for anal squamous intraepithelial lesions in women. Journal of the
National Cancer Institute, 93: 843–849.
17
HIV Screening and Women’s Health
References (continued)
Jamieson, D.J., Duerr, A., Burk, R., Klein, R.S., Cu-Uvins, S., Paramsothy, P. Shah, K., & Schuman,
P. (2002). HIV Epidemiology Research Study (HERS). Characterization of genital human
papillomavirus infection in women who have or who are at risk of having HIV infection. American
Journal of Obstetrics & Gynecology, 186: 21–27.
Kiviat, N.B., Critchlow, C.W., Holmes, K.K., Kuypers, J., Sayer, J., & Dunphy, C. (1993). Association
of anal dysplasia and human papillomavirus with immunosuppression and HIV infection among
homosexual men. AIDS, 7: 43–49.
Korn, A.P. & Landers, D.V. (1995). Gynecologic disease in women infected with human
immunodeficiency virus type 1. Journal of Acquired Immune Deficiency Syndromes & Human
Retrovirology. 9 (4): 361-70.
Lacey, H.B., Wilson, G.E., & Tilston, P. (1999). A study of anal intraepithelial neoplasia in HIVpositive homosexual men. Sexually Transmitted Infections, 75: 172–177.
Larkin, J.A., Minerva, K., Hold, D., & Nadler, J. (1999). Women and HIV: When to Test? AIDS
Reader, 9 (3): 175-183.
Luque, A.E., Demeter, L.M., & Reichman, R.C. (1999). Association of human papillomavirus
infection and disease with magnitude of human immunodeficiency virus type 1 (HIV-1) RNA
plasma level among women with HIV-1 infection. Journal of Infectious Diseases, 179: 1405–
1409.
Maiman, M., Fruchter, R.G., Serur, E., Remy, J.C., Feuer, G., & Boyce, J. (1990). Human
immunodeficiency virus infection and cervical neoplasia. Gynecological Oncology, 38: 377–382.
Massoud et al. (2000). Conf Retroviruses and Opportunistic Infections (abstract 675).
Minkoff H.L., Eisenberger-Matityahu, D., Feldman, J., Burk, R., & Clarke, L. (1999). Prevalence and
incidence of gynecologic disorders among women infected with human immunodeficiency virus.
American Journal of Obstetrics & Gynecology, 180: 824–836.
18
HIV Screening and Women’s Health
References (continued)
Minkoff, H., Feldman, J., DeHovitz, J., Landesman, S., & Burk, R. (1998). A longitudinal study of
human papillomavirus carriage in human immunodeficiency virus-infected and human
immunodeficiency virus-uninfected women. American Journal of Obstetrics & Gynecology, 178:
982–986.
Palefsky, J.M., Holly, E.A., Hogeboom, C.J., Berry, J.M., Jay, N., & Darragh, T.M. (1997) Anal cytology
as a screening tool for anal squamous intraepithelial lesions. Journal of Acquired Immune
Deficiency Syndromes ,14: 415–422.
Palefsky, J.M., Holly, E.A., Ralston, M.L., Da Costa, M., & Greenblatt, R.M. (2001a). Prevalence and
risk factors for anal human papillomavirus infection in human immunodeficiency virus (HIV)positive and high-risk HIV-negative women. Journal of Infectious Diseases, 183: 383–391.
Palefsky, J.M., Minkoff, H., Kalish, L.A., Levine, A., Sacks, H.S., Garcia, P., Young, M., Melnick, S.,
Miotti, P., & Burk, R. (1999). Cervicovaginal human papillomavirus infection in human
immunodeficiency virus-1 (HIV)-positive and high risk HIV-negative women. Journal of the
National Cancer Institute, 91: 226–236.
Petry, K.U., Kochel, H., Bode, U., Schedel, I., Niesert, S., Glaubitz, M., Maschek, H., & Kuhnle, H.
(1996). Human papillomavirus is associated with the frequent detection of warty and basaloid
high-grade neoplasia of the vulva and cervical neoplasia among immunocompromised women.
Gynecologic Oncology, 60: 30–34.
Schuman, P., Ohmit, S.E., Vazquez, J., Klein, R.S., Mayer, K., Rompalo, A., Jamieson, D., & Sobel,
J.D. (2000). Longitudinal assessments of oral and vaginal candida colonization, species, and
fluconazole susceptibility in HIV-seropositive women. The HER study. Conf Retroviruses
Opportunistic Infect 2000 Jan 30-Feb 2; 7:202 (abstract no. 676)
Sun, X.W., Ellerbrock, T.V., Lungu, O., Chiasson, M.A., Bush, T.J., & Wright, T.C. (1995). Human
papillomavirus infection in HIV-seropositive women. Obstetrics & Gynecology, 85: 680–686.
19
HIV Screening and Women’s Health
References (continued)
Sun, X.W., Kuhn, L., Ellerbrock, T.V., Chiasson, M.A., Bush, T.J., & Wright, T.C. (1997). Human
papillomavirus infection in women infected with the human immunodeficiency virus. New
England Journal of Medicine, 337: 1343–1349.
The AIDS Reader. (2000). Genital Warts in HIV. Retrieved on January 2, 2008 from
http://www.medscape.com/viewarticle/410246_5
Uberti-Foppa, C., Origoni, M., Maillard, M., Ferrari, D., Cuiffreda, D., Mastrorilli, E., Lassarin, A., &
Lillo, F. (1998). Evaluation of the detection of human papillomavirus genotypes in cervical
specimens by hybrid capture as screening for precancerous lesions in HIV-positive women.
Journal of Medical Virology, 56: 133–137.
Williams, A., Darragh, T.M., Vranizan, K., Ochia, C., Moss, A.R., & Palefsky, J.M. (1994). Anal and
cervical human papillomavirus infection and risk of anal and cervical epithelial abnormalities in
human immunodeficiency virus-infected women. Obstetrics & Gynecology, 83: 205–211.
20
HIV Screening and Women’s Health
Related documents