Lower Genital Tract Infections Among HIV-Infected and... : Sexually Transmitted Diseases (original) (raw)

Original Articles

Lower Genital Tract Infections Among HIV-Infected and High-Risk Uninfected Women

Findings of the Women's Interagency HIV Study (WIHS)

Greenblatt, Ruth M. MD*; Bacchetti, Peter PhD*; Barkan, Susan PhD†; Augenbraun, Michael MD‡; Silver, Sylvia DA§; Delapenha, Robert MD, FACP∥; Garcia, Patricia MD, PhD¶; Mathur, Usha MD**; Miotti, Paolo MD††; Burns, David MD‡‡ For the Wihs Collaborative Study Group, U.S.A.

*From the University of California, San Francisco, San Francisco, California; †New England Research Institute; Watertown, Massachusetts; ‡State University of New York at Brooklyn, New York, New York; §George Washington University, Washington, DC; ∥Howard University, Washington, DC; ¶Northwestern University, Chicago, Illinois; **Beth Israel Medical Center, New York, New York; ††National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; and ‡‡National Institute of Child Health and Human Development, Bethesda, Maryland

Funding was provided by the National Institute of Allergy and Infectious Diseases, with supplemental funding from the National Cancer Institute, the National Institute of Child Health & Human Development, the National Institute on Drug Abuse, the National Institute of Dental Research, the Agency for Health Care Policy and Research, and the Centers for Disease Control and Prevention. U01-AI-35004, U01-AI-31834, U01-AI-34994, AI-34989, U01-HD-32632 (NICHD), U01-AI-34993, U01-AI-42590.

Data used in this manuscript were collected by the Women's Interagency HIV Study (WIHS) Collaborative Study Group with centers (Principal Investigators) at New York City/Bronx Consortium (Kathryn Anastos); Brooklyn, NY (Howard Minkoff); Washington DC Metropolitan Consortium (Mary Young); The Connie Wofsy Study Consortium of Northern California (Ruth Greenblatt, Herminia Palacio); Los Angeles County/Southern California Consortium (Alexandra Levine); Chicago Consortium (Mardge Cohen); Data Coordinating Center (Alvaro Muñoz, Stephen J. Gange).

The authors thank Drs. Alvaro Muñoz and L. Stewart Massad for their helpful suggestions regarding this manuscript, the participants of this study, and the WIHS Community Advisory Board for their considerate contributions to this study.

Reprint requests: Ruth M. Greenblatt, MD, Infectious Diseases Division, Department of Medicine, University of California, San Francisco, Box 1352, San Francisco, CA 94143.

Received for publication August 26, 1998, revised December 4, 1998, and accepted December 14, 1998.

Abstract

Background and Objectives:

Few comparisons of factors associated with sexually transmitted diseases (STDs) and HIV are available for representative samples of American women.

Goal of the Study:

To compare factors associated with STDs in a large sample of women infected with HIV and women not infected with HIV.

Study Design:

A cross-sectional analysis of STDs in 2,058 women seropositive (HIV+) for HIV and 567 women seronegative (HIV−) for HIV.

Results:

HIV+ women were more likely than HIV− women to report previous STDs, with the exceptions of chlamydia and bacterial vaginosis. Both HIV status and CD4 lymphocyte count were associated with evidence of genital ulcerations, warts, and vaginal candidiasis (p <0.001 for all). HIV− women were more apt to report recent vaginal intercourse (p <0.001), a factor that was independently associated with the occurrence of bacterial and protozoan infections. CD4 lymphocyte depletion was the factor most closely associated with the expression of chronic viral infections.

Conclusions:

In this North American cohort, HIV+ women were more likely than HIV− women to report previous genital tract infections and symptoms. However, the HIV+ women reported less recent sexual activity and few gonococcal or chlamydial infections.