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HIV/AIDS Case-Finding In Family Planning Clinics

HIV/AIDS Case-Finding In Family Planning Clinics. Midwest AIDS Training & Education Center. Health Care Education & Training, Inc. Section 5: Gynecological Manifestations of HIV Disease. Objectives for Section 5.

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HIV/AIDS Case-Finding In Family Planning Clinics

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  1. HIV/AIDS Case-FindingIn Family Planning Clinics Midwest AIDS Training & Education Center Health Care Education & Training, Inc.

  2. Section 5:Gynecological Manifestations of HIV Disease

  3. Objectives for Section 5 Discuss the role of a variety of gynecological problems in identifying the need for recommending HIV testing, including: • Vaginal discharge / irritation • Abnormal uterine bleeding / amenorrhea • Abnormal pap smear • Genital warts • Genital ulcers • Pelvic / abdominal pain & Pelvic Inflammatory Disease

  4. CDC HIV/AIDS Classification System

  5. Vaginal Discharge/Irritation • Women with frequent and/or persistent vaginal discharge should be offered an HIV test. • Differential diagnoses for vaginal discharge include: bacterial vaginosis, vaginal candidiasis, trichomoniasis, gonorrhea, chlamydia. • Studies show an increased colonization of yeast in HIV positive women; therefore, frequent and persistent yeast infections might be a red flag for testing.

  6. Recurrent Yeast Vaginitis as a Common Presenting Symptom of HIV

  7. Abnormal Uterine Bleeding • Abnormal uterine bleeding / menstrual disorders are very common among HIV positive women • Bleeding may not be due to HIV disease, but possibly to related factors: weight loss, chronic disease, substance abuse, and use of progesterone (for appetite stimulation or contraception)

  8. Abnormal Pap Smear • 30-60% of pap smears from HIV positive women have cytological abnormalities. • 15-40% of these pap smears exhibit dysplasia. • Causes of abnormal pap smears (related to HIV disease) include: presence of human papillomavirus, cervical dysplasia, and cervical cancer.

  9. Massad, et al., Abstract 675, 7th CROI, Feb 2000 Abnormal Pap Smears inHIV-Positive Women Genital Tract Neoplasia

  10. Genital Tract Neoplasia • Adequacy of Specimen: • Satisfactory or Unsatisfactory • General Categorization: • Negative for intraepithelial lesion or malignancy • Epithelial Cell Abnormalities: • Atypical Squamous Cells (ASC) • Atypical squamous cells of undetermined significance (ASC-US) • Atypical squamous cells of undetermined significance cannot • exclude high-grade squamous intraepithelial lesion (ASC-H) • http://www.asccp.org/ (**click consensus guidelines) • http://jama.ama-assn.org/issues/v287n16/ffull/jst10014.html Bethesda 2001 Classification

  11. Genital Tract Neoplasia • Epithelial Cell Abnormalities: • Low-grade squamous intraepithelial lesion (LSIL): HPV/mild dysplasia • High-grade squamous intraepithelial lesion (HSIL): moderate & severe dysplasia, carcinoma in situ; CIN 2 and CIN 3 • Squamous Cell Carcinoma • http://www.asccp.org/ (**click consensus guidelines) • http://jama.ama-assn.org/issues/v287n16/ffull/jst10014.html Bethesda 2001 Classification

  12. Genital Tract Neoplasia Bethesda 2001 Classification Glandular Abnormalities: • Atypical Glandular Cells (AGC) • Atypical Glandular Cells, favor neoplastic • Adenocarcinoma In Situ (AIS) • Adenocarcinoma http://www.asccp.org/ (**click consensus guidelines) http://jama.ama-assn.org/issues/v287n16/ffull/jst10014.html

  13. Cervical Dysplasia

  14. Genital Warts • HIV positive women are more likely to be coinfected with HPV. • Prevalence of HPV and severity can be greater with increasing immunosuppression.

  15. HPV as a CommonPresenting Symptom of HIV Before Treatment After Treatment

  16. Genital Ulcers • Diseases which present with genital ulcers and may be associated with HIV disease, include: herpes, syphilis, chancroid, cytomegalovirus, lymphogranuloma venereum, granuloma inguinale, and tuberculosis. • Women with HIV often experience more severe manifestations of these diseases due to immunosuppression. • Genital ulcers serve as a portal of entry for HIV; thus women affected by such ulcers are at a greater risk of infection.

  17. Pelvic / Abdominal Pain • Pelvic and/or abdominal pain are often associated with pelvic inflammatory disease or pregnancy. • Many studies have shown an increased prevalence of HIV in hospitalized PID patients, indicating that providers should offer women with PID an HIV test. • All pregnant women should be offered an HIV test, as part of routine prenatal care.

  18. 41% 59% Co-Occurrence of HIV and Gynecologic Disorders Women with gynecologic disorder(s) at enrollment • Anogenital warts • Syphilis • Amenorrhea • Symptomatic • candidiasis • Oncogenic HPV • Abnormal pap • smear Minkoff et al. 1999 Obstet and Gynecol

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