Comparison of gynecologic history and laboratory results in HIV-positive women with CD4(+) lymphocyte counts between 200 and 500 cells/mu l and below100 cells/mu l

Objective: To assess rates of sexual activity, contraceptive use, genital i nfections and dysplasia, and other gynecologic symptoms among well-characte rized populations of HIV-seropositive women enrolled in two Adult AIDS Clin ical Trials Group (AACTG) randomized studies. Methods: Gynecologic data were collected using standardized interview and e xamination forms from women enrolled in two protocols: ACTG 175, an antiret roviral trial (CD4(+) lymphocyte counts 200-500 cells/mu l) and ACTG 196, a Mycobacterium avium complex prophylaxis trial (CD4(+) counts less than or equal to 100 cells/mu l). Results: Women enrolled in the two studies were similar in age, race, weigh t, and history of illicit or injection drug use, but women in ACTG 196 (n = 67) had lower median CD4(+) counts (median, 35 cells/mu l; range, 0-135 ce lls/mu l versus median, 356 cells/mu l; range, 131-620 cells/mu l; p <.0005 ), were less likely to be antiretroviral naive (6% versus 38%; p <.0005), a nd were more likely to have a Karnofsky score <80 (28% versus 5%; p <.0001) than women in ACTG 175 (n = 185) at baseline. Recent changes in menstrual cycle were not different between groups. Women enrolled in ACTG 196 were le ss likely to be sexually active (40% versus 61%; p <.005), but both groups reported high levels of contraceptive use. Papanicolaou smear results in AC TG 196 and ACTG 175 respectively, were: normal, 38% and 50%, atypia, 24% an d 39%, low-grade squamous intraepithelial lesions (SIL), 27% and 10%, and h igh-grade Sn, 11% and 0.7% (p <.001). Conclusions: Gynecologic complications are common among HIV-seropositive wo men with CD4(+) lymphocyte counts < 500 cells/mu l and are more common and severe among those with more advanced immunosuppression.