At the National Conference for Women and HIV (May 4-7, Pasadena, CA) there were two presentations on pelvic inflammatory disease (PID) in HIV infection. Ann Duerr (of the CDC) presented a "state-of-the-art" lecture on gynecologic infections at 8:30 on Tuesday morning. The audience, especially women living with HIV, was rapt. Clinicians and patients continue to feel that pelvic infections are the overlooked stepchild of the AIDS epidemic. Unlike other bacterial infections in HIV/AIDS (e.g. chronic sinus infections or recurrent bacterial pneumonias) the literature has barely a handful of articles (Safrin, 1990; Sperling, 1991; Korn, 1993) describing the epidemiology, disease course, prophylaxis and/or response to therapy. PID takes its toll on women's health and quality of life, but does not have infectious disease (ID) specialists or OB/GYN specialists competing to be "recognized experts."
Duerr recently coauthored a study comparing PID in positive and negative women (Barbosa, 1997). In this study, conducted at Kings County Hospital in Brooklyn, HIV testing was conducted on blinded blood samples of 423 women admitted for PID, and outcomes were evaluated by blinded review of medical records. The HIV seroprevalence of the women was 8%, far exceeding the seroprevalence rates (2.3%) observed for obstetrical admissions during this period, at the hospital. The HIV-positive women had higher temperatures at admission and lower white blood counts. They were more likely to continue to have fever two to four days after beginning antibiotic therapy. In addition, HIV-positive women were almost five times more likely to require a change of antibiotics and have longer hospital stays. In this study, positive women did not undergo more surgery, or have a higher incidence of tubo-ovarian abscesses. Positive women did have higher rates of surgery in a PID outcome study conducted in Abidjan, Ivory Coast (Kmenga, 1995). The CDC study concluded that PID has a more complicated course in HIV infection; it recommended further studies with larger cohorts and longer follow-up to assess long-term outcomes. The findings support current CDC recommendations that women with PID be offered HIV counseling and testing, and that known HIV-positive women with PID should be hospitalized for treatment.
In the second presentation on PID at the Conference, Anne Moorman reported results from a study in which positive and negative women with PID were compared for the types of pathogens that were present in the uterus at the time of the PID diagnosis. Transcervical and endometrial biopsies were performed to collect samples for testing. Positive women were significantly more likely than negative women to harbor mycoplasma, streptococci species and cytomegalovirus; but not gonorrhea, chlamydia, gardnerella vaginalis, herpes simplex virus or human papillomavirus. The negative women were more likely to show signs of acute infection, while the positive women were more likely to show signs of chronic infection.
_Barbosa C et al. Obstetrics and Gynecology. January 1997; 89(1):65-70
Kamenga M et al. American Journal of Obstetrics and Gynecology. March 1995; 172(3):919-25.
Korn AP et al. Obstetrics & Gynecology. November 1993; 82(5):765-8.
Moorman AC et al. National Conference on Women and HlV. May 1997; abstract 103.6.
Safrin S et al. Obstetrics & Gynecology. April 1990; 75(4):666-70.
Sperling RS et al. Journal of Reproductive Medicine. February 1991; 36(2):122-4.