High prevalence of abnormal menstruation among women living with HIV in Canada

English version

Autoři: Christina Valiaveettil ^aff001; Mona Loutfy ^aff002; V. Logan Kennedy ^aff003; Sheila Caddy ^aff004; Mark Yudin ^aff002; Tracey Conway ^aff003; Erin Ding ^aff006; Paul Sereda ^aff006; Alexandra de Pokomandy ^aff007; Angela Kaida ^aff009;
Působiště autorů: Schulich School of Medicine and Dentistry, Western University, London, ON, Canada ^aff001; Faculty of Medicine, University of Toronto, Toronto, ON, Canada ^aff002; Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada ^aff003; Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada ^aff004; Department of Obstetrics and Gynecology, St. Michael’s Hospital, Toronto, ON, Canada ^aff005; British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada ^aff006; Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada ^aff007; Department of Family Medicine, McGill University, Montreal, QC, Canada ^aff008; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada ^aff009
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0226992

Souhrn

Objectives

To measure the prevalence and correlates of abnormal menstruation among women living with HIV (WLWH) in Canada.

Methods

We used cross-sectional questionnaire data from the community-based Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS), which enrolled WLWH aged ≥16 from British Columbia (BC), Ontario, and Quebec. For this analysis, we excluded women >45 years, who had primary amenorrhea, were pregnant, on hormonal contraception, or who reported history of endometrial cancer, last menstrual period >12 months ago, or premature ovarian failure. The primary outcome was abnormal menstruation (Yes vs No) based on responses to five questions about menstrual regularity, frequency, volume, duration, and intermenstrual bleeding in the six months prior to interview. An exploratory multivariable logistic regression analysis examined independent correlates of abnormal menstruation.

Results

Of 1422 women enrolled, 521 (37%) met eligibility criteria. Overall, 55.9% (95% CI:52%-60%) reported abnormal menstruation. In adjusted analyses, abnormal menstruation was associated with having a biologic sister/mother who entered menopause before age 40 (AOR 5.01, 95%CI 1.39–18.03), Hepatitis B co-infection (AOR 6.97, 95%CI 1.52–31.88), current smoking (AOR 1.69, 95%CI 1.55–3.41); and currently taking antiretroviral therapy (ART) (AOR 2.36, 95%CI 1.25–4.45) compared to being ART-naïve. Women in BC had higher adjusted odds of abnormal menstruation (AOR 2.95, 95%CI 1.61–5.39), relative to women in Ontario and Quebec.

Conclusions

Over half of WLWH in this analysis had abnormal menstruation. Correlates of abnormal menstruation include genetic, socio-behavioural factors (province of residence, smoking), Hepatitis B co-infection, and current ART use.

Klíčová slova:

HIV diagnosis and management – Co-infections – Female contraception – Hepatitis B

Zdroje

1. Shah PN, Smith JR, Kitchen VS, Barton SE. HIV infection and the gynaecologist. Br J Obstet Gynaecol. 1994 Mar;101(3):187–9. doi: 10.1111/j.1471-0528.1994.tb13106.x 8193089

2. Ellerbrock TV, Wright TC, Bush TJ, Dole P, Brudney K, Chiasson MA. Characteristics of menstruation in women infected with human immunodeficiency virus. Obstet Gynecol 1996;87:1030. doi: 10.1016/0029-7844(96)00047-6 8649685

3. Ezechi OC, Jogo A, Gab-Okafor C, Onwujekwe DI, Ezeobi PM, Gbajabiamila T, et al. Effect of HIV-1 infection and increasing immunosuppression on menstrual function. J Obstet Gynaecol Res. 2010 Oct;36(5):1053–8. doi: 10.1111/j.1447-0756.2010.01253.x 21058440

4. Minkoff HL, Eisenberger-Matityahu D, Feldman J, Burk R, Clarke L. Prevalence and incidence of gynecologic disorders among women infected with human immunodeficiency virus. Am J Obstet Gynecol. 1999 Apr;180(4):824–36. doi: 10.1016/s0002-9378(99)70653-8 10203650

5. Chirgwin KD, Feldman J, Muneyyirci-Delale O, Landesman S, Minkoff H. Menstrual function in human immunodeficiency virus-infected women without acquired immunodeficiency syndrome. J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Aug 15;12(5):489–94. doi: 10.1097/00042560-199608150-00008 8757426

6. Harlow SD, Schuman P, Cohen M, Ohmit SE, Cu-Uvin S, Lin X, et al. Effect of HIV infection on menstrual cycle length. J Acquir Immune Defic Syndr. 2000 May 1;24(1):68–75 doi: 10.1097/00126334-200005010-00012 10877498

7. Singh S, Best C, Dunn S, Leyland N, Wolfman WL. Clinical Practice Gyneocologic Committee. Abnormal uterine bleeding in pre-menopausal women. J Obstet Gynaecol Can. 2013 May;35(5):473–475. doi: 10.1016/S1701-2163(15)30939-7 23756279

8. Munro MG, Critchley HO, Broder MS, Fraser IS; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011 Apr;113(1):3–13. doi: 10.1016/j.ijgo.2010.11.011 21345435

9. Zon LI, Arkin C, Groopman JE. Haematologic manifestations of the human immune deficiency virus (HIV). Br J Haematol. 1987 Jun;66(2):251–6. doi: 10.1111/j.1365-2141.1987.tb01307.x 3606961

10. Kushnir VA, Lewis W. Human immunodeficiency virus/acquired immunodeficiency syndrome and infertility: emerging problems in the era of highly active antiretrovirals. Fertil Steril. 2011 Sep;96(3):546–53. doi: 10.1016/j.fertnstert.2011.05.094 21722892

11. Schoenbaum EE, Hartel D, Lo Y, Howard AA, Floris-Moore M, Arnsten JH, et al. HIV infection, drug use, and onset of natural menopause. Clin Infect Dis. 2005 Nov 15;41(10):1517–24. Epub 2005 Oct 13. doi: 10.1086/497270 16231267

12. Massad LS, Evans CT, Minkoff H, Watts DH, Greenblatt RM, Levine AM, et al. Effects of HIV infection and its treatment on self-reported menstrual abnormalities in women. J Womens Health (Larchmt). 2006 Jun;15(5):591–8.

13. Lam C, Anderson B, Lopes V, Schulkin J, Matteson K. Assessing Abnormal Uterine Bleeding: Are Physicians Taking a Meaningful Clinical History? J Womens Health (Larchmt). 2017 Jul;26(7):762–767. Epub 2017 Mar 20.

14. Cozza G, Pinto A, Giovanale V, Bianchi P, Guarino A, Marziani R, et al. Comparative effectiveness and impact on health-related quality of life of hysterectomy vs. levonorgestrel intra-uterine system for abnormal uterine bleeding. Eur Rev Med Pharmacol Sci. 2017 May;21(9):2255–2260. 28537655

15. Santoro N, Arnsten JH, Buono D, Howard AA, Schoenbaum EE. Impact of street drug use, HIV infection, and highly active antiretroviral therapy on reproductive hormones in middle-aged women. J Womens Health (Larchmt). 2005 Dec;14(10):898–905.

16. Ogundahunsi OA, Ogundipe MO, Akinola NO, Soyinka OO, Odewabi AO, Oyegunle VA. The effect of HIV and antiretroviral therapy on fertility hormones in amenorrheic HIV-positive women. African Scientist Vol. 11, No. 3, September 30, 2011

17. Harlow SD, Cohen M, Ohmit SE, Schuman P, Cu-Uvin S, Lin X, et al. Substance use and psychotherapeutic medications: a likelycontributor to menstrual disorders in women who are seropositive for human immunodeficiency virus. Am J Obstet Gynecol. 2003 Apr;188(4):881–6. doi: 10.1067/mob.2003.209 12712080

18. Fumaz CR, Muñoz-Moreno JA, Ferrer MJ, Negredo E, Pérez-Alvarez N, Tarrats A et al. Low levels of adherence to antiretroviral therapy in HIV-1-infected women with menstrual disorders. AIDS Patient Care STDS. 2009 Jun;23(6):463–8. doi: 10.1089/apc.2009.0016 19519230

19. Kaida A, Carter A, Nicholson V, Lemay J, O'Brien N, Greene S et al. Hiring, training and supporting peer research associates: operationalizing community-based research principles within epidemiological studies by, with, and for women living with HIV Harm Reduction Journal. 2019;16(1):47.

20. Akaike H. (2011) Akaike’s Information Criterion. In: Lovric M. (eds) International Encyclopedia of Statistical Science. Springer, Berlin, Heidelberg

21. Monroe A. Menstruation, menopause, and HIV. BETA. 2007 Winter;19(2):39–44. 17489115

22. Brown S, Vessey M, Stratton I. The influence of method of contraception and cigarette smoking on menstrual patterns. Br J Obstet Gynaecol. 1988 Sep;95(9):905–10. doi: 10.1111/j.1471-0528.1988.tb06578.x 3191064

23. Mishra GD, Dobson AJ, Schofield MJ. Cigarette smoking, menstrual symptoms and miscarriage among young women. Aust N Z J Public Health. 2000 Aug;24(4):413–20. doi: 10.1111/j.1467-842x.2000.tb01604.x 11011470

24. Grossman MP, Nakajima ST. Menstrual cycle bleeding patterns in cigarette smokers. Contraception. 2006 Jun;73(6):562–5. Epub 2006 Apr 27 doi: 10.1016/j.contraception.2006.01.016 16730484

25. Yeh J, Barbieri RL. Twenty-four-hour urinary-free cortisol in premenopausal cigarette smokers and nonsmokers. Fertil Steril. 1989 Dec;52(6):1067–9. doi: 10.1016/s0015-0282(16)53177-x 2531683

26. Rosenberg MJ, Waugh MS, Stevens CM. Smoking and cycle control among oral contraceptive users. Am J Obstet Gynecol. 1996 Feb;174(2):628–32. doi: 10.1016/s0002-9378(96)70440-4 8623797

27. Michaud SE, Ménard C, Guy LG, Gennaro G, Rivard A. Inhibition of hypoxia-induced angiogenesis by cigarette smoke exposure: impairment of the HIF-1alpha/VEGF pathway. FASEB J. 2003 Jun;17(9):1150–2. Epub 2003 Apr 22. doi: 10.1096/fj.02-0172fje 12709416

28. Lip PL, Belgore F, Blann AD, Hope-Ross MW, Gibson JM, Lip GY. Plasma VEGF and soluble VEGF receptor FLT-1 in proliferative retinopathy: relationship to endothelial dysfunction and laser treatment. Invest Ophthalmol Vis Sci. 2000 Jul;41(8):2115–9. 10892852

29. Kaida A, Patterson S, Carter A, Loutfy M, Ding E, Sereda P, et al. Contraceptive Choice and Use of Dual Protection Among Women Living with HIV in Canada: Priorities for Integrated Care. Perspect Sex Reprod Health. 2017;49(4):223–36. doi: 10.1363/psrh.12046 29193584