VIII International Conference on AIDS: Women and HIV

VIII International Conference on AIDS: Women and HIV

Seattle Treatment Education Project: STEP Perspective - Volume 4, Number 3 - October 1992
Mari Kitahata, M.D.

Twenty sessions at this year's International Conference on AIDS were devoted to clinical, epidemiologic and social issues concerning women with HIV disease. One oral session focused on gender-related variations in the natural history of HIV disease. At this session four studies were reviewed comparing the clinical course of HIV infection in women to men. They found no significant differences in disease progression, risk for development of specific opportunistic infections, or survival rates (MoC0030, MoC0031, MoC0032, MoC0033). One of these studies presented by Terri Creagh, (MoC0032) reported that women with less than 100 CD4 cells had a shorter survival time than men, but gender was not a predictor of outcome when AZT use was taken into account. This finding points to possible differences in access to medical care between women and men. An additional study presented by Constance Benson (MoC0034) followed 63 women for up to 57 months and found that among those with class IV diagnosis (AIDS), Candida esophagitis (65 percent) was the most frequent opportunistic infection seen (the same trend also noted in the study presented by Community Programs for Clinical Research on AIDS, MoC0031). Pneumocystis Carinii Pneumonia was second most frequent diagnosis (40 percent), with Mycobacterium Avium Complex (MAC) disease running third (30 percent). Gynecologic abnormalities occurred in 33 percent, including recurrent Candida vaginitis in 32 percent, abnormal PAP smears/CIN in 10 percent, and Pelvic Inflammatory Disease (PID) in 8 pecent. At the conclusion of this session, a presenter, Dr. Sally Zierler of Brown University, pointed out the difficulties in accurately defining the clinical course of HIV infection in women when using the natural history of HIV disease in men as the standard for comparison.

Another oral session on clinical manifestations of HIV in women focused on studies of cervical dysplasia. Six observational studies were presented with conflicting data regarding the correlation of the grade of abnormality and CD4 counts, and the need for colposcopy (an examination of the cervix and vagina by the instrument colposcope). Robert Klein and colleagues (TuB0527) reported a higher rate of squamous intraepithelial lesions (SIL) on PAP smears in HIV-positive women (25 percent) than HIV-negative women with SIL who went on to colposcopy. PAP smear reliably predicted colposcopic findings/histologic outcome in 93 percent. Nina Regevik and colleagues (TuB0528) evaluated 45 HIV-positive women in an HIV/AIDS women's clinic. All women positive for Human Papillomavirus (HPV) with CD4 counts below 500 had abnormal PAP smears. They conclude that HIV- infected women with CD4 counts below 500 and evidence of HPV infection may be at a higher risk for developing neoplastic changes of the cervix, and warrant more frequent and aggressive screening.

In a retrospective review of 78 HIV-positive women at the Johns Hopkins Hospital HIV clinic (TuB0530), 18 (62 percent) had abnormal PAP smears. Kathryn Anastos and cooleagues (TuB0532) examined the relationship of immune function, as measured by CD4 counts, and clinical disease stage with the prevalence of cervical cell abnormalities in HIV infected women in an inner city community. PAP smears were obtained from 131 women. This study concludes that advanced cervical cell abnormalities in HIV infected women are associated with advanced disease as measured by both clinical (disease stage) and immunologic (CD4 cell count) markers. Further controlled prospective trials are needed to determine if immunosuppression affects the incidence and progression of HPV infection and cervical dysplasia in HIV-positive women.

Always watch for outdated information. This article first appeard in 1992. This material is designed to support, not replace, the relationship that exists between you and your doctor.

Copyright © 1992 - Seattle Treatment Education Project (STEP) - All rights reserved. Noncommercial reproduction is encouraged. STEP is published four times a year by the Seattle Treatment Education Project, 127 Broadway East, 3rd Floor, Seattle, WA 98102. Email: step100@aol.com STEP web page

This information is designed to support, not replace, the relationship that exists between you and your doctor.
©1992. AEGIS.