Effect of HIV-1 infection and increasing immunosuppression on menstrual function.
OBJECTIVE
The aim of this study was to determine the prevalence, pattern and determinants of menstrual abnormalities in HIV-positive Nigerian women.


METHODS
A cross-sectional study was carried out involving 3473 (2549 HIV-seropositive and 924 seronegative) consecutive and consenting women seen at the HIV treatment centers at the Nigerian Institute of Medical Research, Lagos and the Federal Medical Centre, Markurdi.


RESULTS
The sociodemographic characteristics of the two groups were comparable, except for body mass index (BMI): the HIV-negative women (28.1 ± 8.1) had statistically significantly (P < 0.005) higher BMI compared to the HIV-positive women (21.9 ± 7.5). Menstrual abnormalities were significantly more common in women living with HIV/AIDS (29.1%) compared to the HIV-negative (18.9%) women (P < 0.001). The proportions of women in the two groups with intermenstrual bleeding, menorrhagia, hypermenorrhea, and postcoital bleeding were similar (P > 0.005), however amenorrhea, oligomenorrhea, irregular periods and secondary dysmenorrhea were more common in the HIV-positive women (P < 0.02). Primary dysmenorrhea was less common in HIV-positive women (P < 0.03). Among the HIV-positive women, menstrual dysfunction was more common in women living with HIV/AIDS with opportunistic infections, CD4 count < 200, not undertaking therapy, symptomatic disease and BMI < 20. However, after controlling for cofounders, only CD4 < 200 (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.2-9.7), BMI < 20 (OR, 2.4; 95%CI, 1.3-3.5) and not taking antiretroviral drugs (OR, 2.05; CI, 1.7-6.5) were associated with amenorrhea, oligomenorrhea, irregular periods and secondary dysmenorrhea.


CONCLUSIONS
HIV-positive women in this study experienced more menstrual abnormalities of amenorrhea, oligomenorrhea, and irregular periods compared to the HIV-negative controls. HIV-positive women with CD4 count < 200, BMI < 20 and who do not take antiretroviral drugs are at the greatest risk.
Sexual and Reproductive Health Research Unit, Clinical Sciences Division, Nigerian Institute of Medical Research, Lagos, Nigeria. oezechi@ yahoo.co.uk
Oliver C
OC
Ezechi
Andrea
A
Jogo
Chidinma
C
Gab-Okafor
Dan I
DI
Onwujekwe
Paschal M
PM
Ezeobi
Titi
T
Gbajabiamila
Rosemary A
RA
Adu
Rosemary A
RA
Audu
Adesola Z
AZ
Musa
Olumuyiwa B
OB
Salu
Emily
E
Meschack
Ebiere
E
Herbertson
Nkiru
N
Odunukwe
Oni E
OE
Idigbe
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006679:HIV Seropositivity / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007165:Immunosuppression Therapy; D008599:Menstruation Disturbances / Q000150:complications / Q000453:epidemiology*; D009549:Nigeria / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors