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Susan Brogly, Heather Watts, Nathalie Ylitalo, Eduardo Franco, George Seage III, James Oleske,

Reproductive health of adolescent girls perinatally infected with HIV 11 th Annual Maternal and Child Health Epidemiology Conference December 7, 2005. Susan Brogly, Heather Watts, Nathalie Ylitalo, Eduardo Franco, George Seage III, James Oleske, Michelle Eagle, Russell Van Dyke. BACKGROUND.

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Susan Brogly, Heather Watts, Nathalie Ylitalo, Eduardo Franco, George Seage III, James Oleske,

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  1. Reproductive health of adolescent girls perinatally infected with HIV11th Annual Maternal and Child Health Epidemiology ConferenceDecember 7, 2005 Susan Brogly, Heather Watts, Nathalie Ylitalo, Eduardo Franco, George Seage III, James Oleske, Michelle Eagle, Russell Van Dyke

  2. BACKGROUND • Rate of pregnancy in perinatally HIV infected girls and effectiveness of antiretroviral therapy (ART) in preventing 2nd generation perinatal HIV transmission unknown • High rate of cervical human papilloma virus (HPV) infection and squamous intraepithelial lesions (SIL) in women & adolescents infected with HIV through drug and sexual behaviors • This has not been studied in perinatally HIV infected adolescent girls

  3. OBJECTIVES • To estimate the rate of pregnancy, genital infections, and cervical dysplasia in a US cohort of perinatally HIV infected adolescent females • To identify the demographic and HIV disease related characteristics associated with these outcomes

  4. STUDY POPULATION • Source population PACTG 219C cohort • 1,305 perinatally HIV-infected girls • Study population: • 453 perinatally HIV-infected girls 14 years of age • From 73 clinics in 23 states and Puerto Rico • Median follow-up 29.2 months (10th, 90th: 4.9, 72.7) from their 14th birthday • 160 (35.3%) known to be sexually active

  5. DATA COLLECTION • Every 3 months histories of clinical diagnoses, pregnancy & ART use collected • Annual pelvic examinations taken in sexually active girls • Frequently screened for genital infections (condyloma, Chlamydia, trichomoniasis, syphilis, gonorrhea) at this time • Annual cervical Papanicolaou (Pap) smear examinations taken in sexually active girls • Pap smears fixed using spray preservative and sent to the local institution’s laboratory for review • Diagnoses of ASCUS, LSIL, HSIL made according to the Bethesda system for cytological specimens

  6. STATISTICAL ANALYSIS • Estimated the incidence rate of: • Pregnancy • Genital infections (condyloma, Chlamydia, trichomoniasis, syphilis, gonorrhea) • Abnormal cervical cytology • Differences characteristics of girls with and without above outcomes assessed with Fisher exact and Kruskal-Wallis tests

  7. INCIDENCE OF 1st PREGNANCY 25.6/1,000 pyrs (17.4-36.4) 14 to 23 years 34.9/1,000 pyrs (23.0-50.8) 15 to 19 years

  8. CHARACTERISTICS BY PREGNANCY STATUS

  9. CHARACTERISTICS CONT’D

  10. PREGNANCY OUTCOMES • 1st pregnancies (N=31) • 23 live births (1 set of twins); 3 spontaneous abortions; 6 therapeutic abortions • 2nd pregnancies (N=3) • 2 live births; 1 therapeutic abortion • All mothers on ART during pregnancy • Infant infection status (N=25) • 1 HIV-infected, 23 uninfected, 1 unknown • HIV transmission rate: 4.0% (95% CI: 0.10-20.35)

  11. GENITAL INFECTIONS

  12. CERVICAL CYTOLOGY • 84 (18.5%) girls had Pap smears - 51.9% of 160 girls known to be sexually active • 41.7% 1 Pap smear, 15.5% 2 Pap smears, and 42.9% ≥ 3 Pap smears • 39 (46.4%) had cervical abnormalities • 1st abnormal cytologic diagnosis: ASCUS (N=16), LSIL (N=21), HSIL (N=2) • Cumulative incidence of SIL at 12 months: 21.97% (4.86-39.08) • Among 20 girls with intervention, 5 cervical abnormalities cleared, 2 regressed to less severe SIL, 8 persisted, and 5 progressed to more severe SIL

  13. LIMITATIONS • Some spontaneously or therapeutically aborted pregnancies may not have been identified • Could have underestimated the pregnancy rate • Screening for genital infections was not performed routinely as part of the 219C protocol • Estimated rates represent minimum rate of genital infections • Analysis of cervical cytology restricted to girls with Pap smears & likely included girls with high-risk sexual behavior • Could have overestimated the rate of abnormal cervical cytology

  14. CONTRIBUTION • Despite the relatively low number of births, ART appears effective in preventing 2nd generation perinatal HIV transmission • 16% of girls pregnant before 20th birthday; 46% had abnormal cervical cytology • 50% of the girls known to be sexually active had Pap smears • Underscores the importance of obtaining sexual histories, recommending routine Pap smears, conservative cytological follow-up, & education on safer sexual practice in this population

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