Influence of human immunodeficiency virus infection on pelvic inflammatorydisease

Objective: To examine the influence of human immunodeficiency virus (HIV) i nfection on clinical and microbiologic characteristics of pelvic inflammato ry disease (PID). Methods: Forty-four HIV-infected women and 163 HIV noninf ected women diagnosed with PID by standard case definition were evaluated b y using clinical severity scores, transabdominal sonograms, and endometrial biopsies. After testing for bacterial infections, patients were prescribed antibiotics as recommended by the Centers for Disease Control and preventi on (CDC). Results: Symptoms of PID and analgesic use before enrollment did not differ by HIV serostatus. More HIV-infected women had received antibiotics before enrollment (40.9% versus 27.2%, P = .08), a factor associated with milder signs regardless of serostatus. More HIV-infected women had sonographically diagnosed adnexal masses at enrollment (45.8% versus 27.1%, P = .08), a di fference that yielded higher median severity scores (17.5 of 42 points vers us 15 of 42 points, P = .07). However, those differences were not significa nt at the P < .05 level. Mycoplasma (50% versus 22%, P < .05) and streptoco ccus species (34% versus 17%, P < .05) were isolated more commonly from bio psies of HIV-infected women. Within 30 days after enrollment, HIV-infected women generally responded as well to therapy as HIV-noninfected women did, regardless of initial CD4 T-lymphocyte percentage. Conclusion: Among women with acute PID, HIV infection was associated with m ore sonographically diagnosed adnexal masses. Clinical response to CDC-reco mmended antibiotics did not differ appreciably by serostatus. Mycoplasmas a nd streptococci were isolated more commonly from HIV-infectcd women, but th ose organisms also might be associated with PID in immunocompetent women. ( C) 2000 by The American College of Obstetricians and Gynecologists.