By Liz Highleyman

Research to date has yielded mixed data about the prevalence of gynecological problems in women with HIV. Some earlier studies revealed high rates of gynecological manifestations in HIV positive women, but these were done before the advent of effective combination antiretroviral therapy when patients still often experienced severely compromised immunity.

As reported in the January 25, 2007 electronic edition of the Journal of Acquired Immune Deficiency Syndromes, researchers aimed to determine rates of and indications for hysterectomy (removal of the uterus) among HIV positive women, and compared them to those of at-risk HIV negative women.

Reports of hysterectomy were collected from 3752 participants in the Women's Interagency HIV Study, a prospective cohort study of women with HIV and comparable at-risk HIV-uninfected women.

Results

• During the follow-up period, 106 out of 2361 HIV positive women (4.5%) received hysterectomies, compared with 24 out of 837 HIV negative women (2.9%) (P = 0.04).

• The incidence of hysterectomy was 7.7 per 1000 person-years for HIV positive women and 5.3 per 1000 person-years for HIV negative women (P = 0.09).

• Among HIV positive women, the most common indication for hysterectomy was cervical neoplasia, a precursor to cervical cancer associated with human papillomavirus (HPV) infection.

• Surgical indications did not differ by HIV serostatus.

• HIV positive and HIV negative women undergoing hysterectomy were similar except for a higher likelihood of abnormal pre-operative Pap test results in women with HIV (P = 0.001).

Conclusion

In conclusion, the authors wrote, "Women with HIV are more likely than uninfected women to require a hysterectomy, most often for cervical neoplasia."

These results -- and data from other studies showing that women with HIV are more likely than HIV negative women to be infected with HPV and to develop cervical neoplasia -- underline the importance of regular Pap smears to detect abnormal cervical cell changes at an early stage when they are more easily treated.

Southern Illinois University School of Medicine, Springfield, IL; University of Illinois, Chicago, IL; Chicago Consortium of the Women's Interagency HIV Study; John H. Stroger Hospital of Cook County, Chicago, IL; Johns Hopkins University School of Public Health, Baltimore, MD; Georgetown University, Washington, DC; State University of New York, Downstate Medical Center, Brooklyn, NY; Pediatric, Adolescent, and Material AIDS Branch, National Institute of Child Health and Human Development, Bethesda, MD.

02/16/07

Reference
L S Massad, C Evans, K Weber, and others. Hysterectomy Among Women With HIV: Indications and Incidence. Journal of Acquired Immune Deficiency Syndromes. January 25, 2007 [Epub ahead of print].