RESUMEN
OBJECTIVES: The aim of the current study was to assess the effect of maternal HIV infection, treated or untreated, on the degree of placental invasion, as assessed by the pulsatility index of the uterine arteries during a Doppler examination at 11(+0) -13(+6) weeks' gestation. METHODS: This was a nested case-control study in which a uterine artery Doppler examination was performed in the first trimester in 76 HIV-positive women. Each woman was matched with 30 HIV-negative women. As the pulsatility index of the uterine arteries depends on a number of maternal and fetal characteristics, its values in each case and control were expressed as multiples of the median (MoM) of the unaffected group. RESULTS: Among the 76 HIV-positive women, 33 (43.4%) were on antiretroviral treatment at the time of the Doppler examination, including 14 women (42.4%) on nucleoside reverse transcriptase inhibitors (NRTIs) and a protease inhibitor, 18 women (54.5%) on NRTIs and a nonnucleoside reverse transcriptase inhibitor and one woman (3.1%) on monotherapy. Compared with the HIV-negative women, the HIV-positive women were more likely to be heavier (P<0.01), to be of African origin (P<0.01), to be nonsmokers (P=0.01) and to deliver smaller neonates earlier (P<0.01). The median adjusted pulsatility index of the uterine arteries was not statistically different between the cases and controls [1.07; interquartile range (IQR) 0.85-1.24 MoM vs. 0.99; IQR 0.81-1.20 MoM; P= 0.28] or, in HIV-positive women, between those receiving and not receiving antiretroviral treatment (P=0.12). CONCLUSIONS: HIV-positive women with uncomplicated pregnancies have normal placental perfusion in the first trimester of pregnancy.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/diagnóstico por imagen , Complicaciones Infecciosas del Embarazo/diagnóstico por imagen , Ultrasonografía Prenatal , Arteria Uterina/diagnóstico por imagen , Adulto , Estudios de Casos y Controles , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/fisiopatología , Inhibidores de la Proteasa del VIH/uso terapéutico , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/fisiopatología , Primer Trimestre del Embarazo , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Arteria Uterina/efectos de los fármacos , Arteria Uterina/fisiopatologíaRESUMEN
This case is about an HIV seropositive young woman referred for the treatment of severe menorrhagia causing anaemia due to adenomyosis where the levonorgestrel-releasing intrauterine system (Mirena) proved useful in treating her heavy periods and also provided effective contraception without interference from the liver enzyme-inducing effects of antiretroviral medications.
Asunto(s)
Anticonceptivos Femeninos/uso terapéutico , Endometriosis , Seropositividad para VIH , Dispositivos Intrauterinos Medicados/estadística & datos numéricos , Levonorgestrel/uso terapéutico , Menorragia , Adulto , Anemia/etiología , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/uso terapéutico , Quimioterapia Combinada , Endometriosis/complicaciones , Endometriosis/tratamiento farmacológico , Femenino , Seropositividad para VIH/complicaciones , Seropositividad para VIH/tratamiento farmacológico , Humanos , Levonorgestrel/administración & dosificación , Menorragia/tratamiento farmacológico , Menorragia/etiología , Nevirapina/administración & dosificación , Nevirapina/uso terapéutico , Inhibidores de la Transcriptasa Inversa/administración & dosificación , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Resultado del TratamientoRESUMEN
HIV-positive women may be reluctant to attend gynaecology or family planning clinics for fear of divulging their condition. Therefore, a referral clinic was opened within the HIV clinic. Retrospective case-note reviews of 197 new patients revealed 109 with a variety of medical gynaecology conditions (menorrhagia being the commonest) and 88 sought contraception. The full range of contraceptives was used, including Mirena for the treatment of menorrhagia as well as contraception and the combined pill adjusted for interaction with liver enzyme-inducing antiretroviral drugs. The acceptance of contraceptive advice and gynaecological evaluation by the patients has resulted in improved reproductive health services for these HIV-positive women. In centres with large cohorts of HIV-positive women, this type of one-stop specialist clinic will be very effective in providing high-quality reproductive health care and hence, this type of clinic is recommended for such centres.
Asunto(s)
Instituciones de Atención Ambulatoria , Anticoncepción , Servicios de Planificación Familiar , Ginecología , Seropositividad para VIH , Adolescente , Adulto , Conducta Anticonceptiva , Femenino , Enfermedades de los Genitales Femeninos/diagnóstico , Enfermedades de los Genitales Femeninos/tratamiento farmacológico , Enfermedades de los Genitales Femeninos/epidemiología , Humanos , Auditoría Médica , Persona de Mediana Edad , Servicios de Salud ReproductivaRESUMEN
Schistosomiasis is uncommon in the UK but is found in migrant populations and in those who travel to areas of endemic schistosomiasis. Apparent clinical symptoms may occur long after the patient has left an endemic area. Female urogenital schistosomiasis (arising from infection by Schistosoma haematobium, endemic in Africa and the Middle East) may show a variety of lesions in the female genital tract, some of which may be misdiagnosed as viral warts. One such case is presented here. A young woman presented with lesions on the labia minora suspected to be viral warts which had not responded to treatment with cryotherapy. Biopsy of the lesions and spun urine microscopy revealed S. haematobium eggs. The lesions resolved following treatment with praziquantel. Clinicians should also be aware of the high rate of urogenital schistosomiasis in women from endemic areas, which is associated with urogynaecological morbidity and also increases the risk of acquisition of HIV infection.
Asunto(s)
Schistosoma haematobium/aislamiento & purificación , Esquistosomiasis Urinaria/diagnóstico , Orina/microbiología , Adulto , Animales , Antihelmínticos/uso terapéutico , Biopsia , Femenino , Humanos , Malaui , Enfermedades Desatendidas , Praziquantel/uso terapéutico , Esquistosomiasis Urinaria/tratamiento farmacológico , Esquistosomiasis Urinaria/virología , Viaje , Resultado del Tratamiento , Reino UnidoRESUMEN
A sample of 123 HIV-positive women aged 50 years and over showed high rates of late diagnosis with CD4 count <350 (71%), significant co-morbidities (90%), high rates of premature menopause (6.8%) and early menopause (6.8%) and cervical cytological abnormalities (47%). Specific interventions to improve care in this group should include yearly cervical cytology, early counselling with regard to reproductive options, menopause management and screening for sexually transmitted infections (STIs).
Asunto(s)
Atención a la Salud , Infecciones por VIH/diagnóstico , Anciano , Anciano de 80 o más Años , Fármacos Anti-VIH/uso terapéutico , Densidad Ósea , Recuento de Linfocito CD4 , Comorbilidad , Diagnóstico Tardío , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , Humanos , Auditoría Médica , Menopausia , Persona de Mediana Edad , Infecciones por Papillomavirus/epidemiología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , Reino Unido/epidemiología , Carga ViralRESUMEN
A 56-year-old man presented complaining of urinary frequency, passing urine eight times per day, urethral irritation and dysuria. Investigations showed no evidence of urinary tract infection or sexually transmitted infections. Three months later he presented, again complaining of increased urinary frequency and urethral irritation. He brought with him a urine specimen containing a small 'worm', 2 mm in length, identified as a drain fly (or moth fly) larva, of the genus Psychoda (dipterous flies). Psychoda lay eggs in organically polluted water such as sewage plants, sink drains or on decaying vegetables and fruits. Urogenital myiasis may arise from hatching of larvae near the urethral opening and ascending migration along the urethra with consequent urethritis. Following larval identification, ivermectin was prescribed and the man's symptoms improved after six weeks.