Prevalence and incidence of gynecologic disorders among women infected with human immunodeficiency virus

OBJECTIVE: Our purpose was to ascertain the prevalence, incidence, and pred ictors of gynecologic disorders among women infected with human immunodefic iency virus. STUDY DESIGN: We serially assessed 292 women infected with human immunodefi ciency virus and 681 uninfected women. Outcomes were incidence and prevalen ce of sexually transmitted diseases, viral shedding, findings of Papanicola ou smears, fungal infections, and menstrual disorders. RESULTS: Women infected with the virus were more likely to have prevalent v ulvovaginal candidiasis (odds ratio 1.80, 95% confidence interval 1.0-3.25, P=.05), oncogenic human papillomavirus (odds ratio 3.79, 95% confidence in terval 2.43-5.91, P=.001), abnormal Papanicolaou smears (odds ratio 5.40, 9 5% confidence interval 3.35-8.78, P=.001), amenorrhea (4.8% vs 0%, P=.05), positive results on Treponema pallidum hemagglutination assay (odds ratio 1 .83, 95% confidence interval 1.16-2.88, P=.01), infection with cytomegalovi rus (odds ratio 4.2, 95% confidence interval 1.82-10.62, P=.001), and genit al warts (odds ratio 6.93, 95% confidence interval 3.16-16.30, P=.001) but were less likely to have Chlamydia trachomatis infection (odds ratio 0.28, 95% confidence interval 0.10-0.66, P=.01). Annual incidence rates among wom en infected with human immunodeficiency virus were 4.0% for candidiasis, 22 .0% for oncogenic human papillomavirus, 11.4% for genital warts, 1.7% for i nfection with C trachomatis, 1.7% for infection with Neisseria gonorrhoeae, 10.3% for Trichomonas vaginalis, 1.1% for positive results on T pallidum h emagglutination assay, 7.4% for an abnormal Papanicolaou smear, and 10.9% f or infection with herpes simplex virus. Overall, 46.9% had at least 1 incid ent condition. Women infected with human immunodeficiency virus were more l ikely to have incident oncogenic human papillomavirus infection (odds ratio 2.0, 95% confidence interval 1.01-3.8), abnormal Papanicolaou smears (odds ratio 7.76, 95% confidence interval 2.08-42.8), and genital warts (odds ra tio 9.32, 95% confidence interval 3.04-38.0). Incidence and prevalence of s exually transmitted diseases and oncogenic human papillomavirus infection i ncreased with increased CD4(+) cell counts, CONCLUSIONS: Women infected with the human immunodeficiency virus are signi ficantly more likely to have prevalent and incident gynecologic disorders b ut not disorders related to risk taking (eg, incident sexually transmitted diseases). The latter disorders increased in women with CD4(+) cell counts >500 cells/mm(3). Clinicians should be aware of these patterns so that they can provide appropriate evaluation and treatment of gynecologic disorders.