Search Our Scientific Publications & Authors

AIDS 2018 Jan;32(2):171-177

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health.

Objective: To evaluate gynecologic cancer treatments in HIV-infected women for adherence to National Comprehensive Cancer Network (NCCN) guidelines and to describe survival by adherence to guidelines.

Design: Beyond cervical cancer, there are little data on treatment and outcomes for these women. This is a retrospective cohort study of HIV-infected women with gynecologic cancers. Read More

Obstet Gynecol 2016 10;128(4):e89-e110

In the United States in 2013, there were an estimated 226,000 women and adolescents living with human immunodeficiency virus (HIV) infection (1). Women with HIV are living longer, healthier lives, so the need for routine and problem-focused gynecologic care has increased. The purpose of this document is to educate clinicians about basic health screening and care, family planning, prepregnancy care, and managing common gynecologic problems for women and adolescents who are infected with HIV. Read More

Obstet Gynecol 2016 Oct;128(4):920-2

In the United States in 2013, there were an estimated 226,000 women and adolescents living with human immunodeficiency virus (HIV) infection (1). Women with HIV are living longer, healthier lives, so the need for routine and problem-focused gynecologic care has increased. The purpose of this document is to educate clinicians about basic health screening and care, family planning, prepregnancy care, and managing common gynecologic problems for women and adolescents who are infected with HIV. Read More

Braz J Infect Dis 2015 Nov-Dec;19(6):557-62. Epub 2015 Aug 7.

Post Graduation Program in Tropical Medicine, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado/ Universidade do Estado do Amazonas, Manaus, AM, Brazil.

Objective: The goal of this study was to determine the prevalence of human papillomavirus infection infection and cervical lesions and its associated factors among HIV infected women attending an AIDS clinic in Amazonas state, Brazil.

Methods: Cross-sectional study. Women attending an AIDS clinic in the city of Manaus between March and December 2011 for gynecological examination were invited to participate. Read More

Infect Dis Obstet Gynecol 2015 8;2015:240613. Epub 2015 Mar 8.

Division of Gynecologic Specialties, Department of Obstetrics & Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.

Objective: To describe the demographic and clinical characteristics of HIV-infected individuals and HIV-affected couples who were referred for preconception counseling (PCC) at a large urban US-based HIV clinic.

Methods: Electronic medical records were reviewed for HIV-infected individuals and HIV-affected couples. Medical, reproductive, surgical, psychosocial, and family history data were abstracted. Read More

Obstet Gynecol 2014 May;123(5):1137-9

Early diagnosis and treatment of human immunodeficiency virus (HIV) can improve survival and reduce morbidity. The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists recommend that females aged 13-64 years be tested at least once in their lifetime and annually thereafter based on factors related to risk. In addition, obstetrician-gynecologists should annually review patients' risk factors for HIV and assess the need for retesting. Read More

Obstet Gynecol 2014 May;123(5):1133-6

Preexposure prophylaxis is defined as the administration of antiretroviral medications to individuals who are not infected with human immunodeficiency virus (HIV) and are at the highest risk of acquiring HIV infection. In combination with other proven HIV-prevention methods, preexposure prophylaxis may be a useful tool for women at the highest risk of HIV acquisition. Obstetrician-gynecologists involved in the care of women using preexposure prophylaxis must reinforce adherence to daily medication. Read More

Am J Obstet Gynecol 2014 Feb 30;210(2):117.e1-7. Epub 2013 Aug 30.

Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD.

Objective: We sought to determine risk factors associated with surgical site infection (SSI) among a cohort of human immunodeficiency virus (HIV)-infected women undergoing hysterectomy during the era of highly active antiretroviral therapy.

Study Design: This is a retrospective study of HIV-infected women who underwent a hysterectomy for benign indications at a tertiary care center. Electronic medical records were reviewed from January 1999 through December 2012. Read More

Womens Health Issues 2012 Nov-Dec;22(6):e563-9. Epub 2012 Aug 30.

The Johns Hopkins Urban Health Institute, Johns Hopkins Bloomberg School of Public Health, Maryland.

Background: Intimate partner violence (IPV) is a serious health concern for women in the United States, and HIV-positive women experience more frequent and severe abuse compared with HIV-negative women. The goals of this study were to determine the prevalence of IPV among HIV-infected women receiving care in an urban clinic and to determine the HIV clinical and mental health correlates of IPV among HIV-positive women.

Methods: We conducted a cross-sectional survey among 196 women visiting an inner-city HIV clinic. Read More

J Assoc Nurses AIDS Care 2012 Jan-Feb;23(1):41-51. Epub 2011 Aug 4.

Mailman School of Public Health of Columbia University, New York, USA.

A cohort of individuals with perinatally acquired HIV is maturing into reproductive age. This study describes pregnancy incidence and outcomes among females ages 15-25 with perinatally acquired HIV infection receiving comprehensive family-centered services in New York City. Chart reviews from 1998-2006 indicated 33 pregnancies among 96 young women. Read More

Obstet Gynecol 2010 Dec;116(6):1492-509

The increased use of screening tests has led to the identification of large numbers of women with human immunodeficiency virus (HIV). Consequently, there is an increased role for obstetrician-gynecologists in caring for infected women. Women infected with HIV are living longer, healthier lives and, therefore, the need for routine gynecologic care has increased. Read More

J Womens Health (Larchmt) 2010 Aug;19(8):1511-8

Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.

Background: Despite an increased risk for cervical cytologic abnormalities, HIV-infected women frequently miss their gynecology appointments. We examined barriers to adherence with gynecologic care in an urban HIV clinic.

Methods: We conducted a cross-sectional survey of 200 women receiving gynecologic services in an urban HIV clinic, followed by focus groups. Read More

J Acquir Immune Defic Syndr 2009 Aug;51(4):430-6

Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Background: HIV-infected women are at increased risk of cervical cytologic abnormalities. HIV treatment guidelines recommend annual Papanicolaou (Pap) tests for HIV-infected women. We assessed screening prevalence and associated factors among HIV-infected women. Read More

Am J Obstet Gynecol 2007 Sep;197(3 Suppl):S132-6

Epidemiology Branch, Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

Despite substantial improvements, perinatal human immunodeficiency virus (HIV) transmission has not been eliminated in the United States. We examined the extent and contribution of missed communication opportunities between obstetric and pediatric providers who cared for HIV-infected women and their infants. This was a retrospective review of HIV-exposed infants whose data were reported to the Centers for Disease Control and Prevention Enhanced Perinatal Surveillance System from 1999-2003 (n = 8115). Read More

Infect Dis Clin North Am 2007 Mar;21(1):133-48, ix

Division of Infectious Diseases, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02806, USA.

Many HIV-infected women are benefiting from highly active antiretroviral therapy and living longer. Their reproductive choices vary over the life cycle, and there is a need to understand the appropriate contraceptives for those not intending pregnancy. There are specific gynecologic issues relevant to HIV-infected women, such as genital tract infections, risk for cervical cancer, and menstrual irregularities. Read More

J Acquir Immune Defic Syndr 2006 Dec;43(5):550-5

Data Center of the Swiss HIV Cohort Study, Lausanne, Switzerland.

Background: According to current recommendations, HIV-infected women should have at least 1 gynecologic examination per year.

Objectives: To analyze factors associated with frequency of gynecologic follow-up and cervical cancer screening among HIV-infected women followed in the Swiss HIV Cohort Study (SHCS).

Methods: Half-yearly questionnaires between April 2001 and December 2004. Read More

J Obstet Gynaecol Res 2006 Jun;32(3):324-9

Female Sexually Transmitted Diseases Unit, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand.

Aim: To assess the results of Pap smear at postpartum scheduled visit, especially the prevalence of squamous cell abnormalities including association with CD4(+) T-lymphocyte count (CD4(+) count) levels at delivery among HIV-infected women between the years 1996 and 2004.

Methods: As part of the research and implementation programs of short course antiretroviral regimens for the prevention of mother to child perinatal HIV transmission in HIV-infected pregnant women delivered at Siriraj hospital, CD4(+) count at delivery and Pap smear at postpartum were evaluated.

Results: Among 636 women, 13. Read More

AIDS Read 2005 Aug;15(8):420-3,426-8

Women's Services, Department of Medicine/Division of HIV/AIDS Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.

Owing to advances in the understanding and treatment of HIV infection, most persons infected with HIV are now living longer, healthier lives. With the dramatic reduction in mother-to-child transmission in the past decade, the outlook on life has changed for women with HIV infection. It is critical that a new strategic plan for prevention of HIV transmission and a proactive approach to reproductive health care be implemented by health care providers who care for these women. Read More

Ann Behav Med 2004 Dec;28(3):195-202

Department of Psychology, University of Miami, Miami, FL, USA.

Background: One of the most common gynecologic conditions among HIV+ women is cervical dysplasia, the precancerous phase of cervical cancer. Therefore, adherence to gynecology visits may be among the most important health care practices for HIV+ women. However, no research has evaluated the psychosocial factors associated with health care practices among HIV+ women at risk for cervical cancer. Read More

Am J Med Sci 2004 Jul;328(1):17-25

HIV Outpatient Program, Charity Hospital, New Orleans, Louisiana, USA.

Women currently account for an increasing proportion of the US population infected with human immunodeficiency virus (HIV). Although women suffer from similar HIV-related complications as men, they also can have unique gynecologic manifestations, such as cervical dysplasia or severe pelvic inflammatory disease. Other gender-specific management issues include contraception and pregnancy. Read More

Ann Intern Med 2002 Feb;136(3):228-42

Keck School of Medicine, University of Southern California, Los Angeles, California, USA.

The rate of newly diagnosed AIDS in the United States is increasing fastest in women, who are infected with HIV primarily through heterosexual transmission. Approximately 60% of these women are African American, and 18% are Latina. A gynecologic infection is the most common symptom that leads to initial medical evaluation. Read More

Arch Med Res 2002 Jan-Feb;33(1):61-6

Departamento de Enfermedades Infecciosas, Instituto Nacional de Cancerología (INCAN), Mexico City, Mexico.

Background: HIV infection in women is a growing problem in developing countries. Risk factors for HIV infection vary from country to country and may change with time.

Methods: We describe a retrospective review of the epidemiologic characteristics and associated gynecologic diseases of all HIV-infected women seen at two tertiary-care hospitals in Mexico City. Read More

J Acquir Immune Defic Syndr 2001 Aug;27(5):463-6

Division of General Internal Medicine, Rhode Island Hospital, Brown University, 593 Eddy Street, Providence, RI 02903, USA.

Objective: We examined the sociodemographic, clinical and provider factors associated with screening for cervical cancer among HIV-infected women.

Methods: We studied a national sample representing 43,490 women receiving treatment of HIV infection who completed first follow-up surveys of the HIV Cost and Service Utilization Study (HCSUS). All women were asked, "In the past 12 months, have you had a Pap test?" Women reporting an abnormal Pap test result were asked whether they had been told antibiotics could cure abnormal cells, and whether they were scheduled for another Pap test or for a colposcopy within 3 months. Read More

J Int Assoc Physicians AIDS Care 1997 Oct;3(10):16-9

University College, Cork, Ireland.

Clin Obstet Gynecol 2001 Jun;44(2):226-42

University of California, San Francisco, California, USA.

Z Geburtshilfe Neonatol 2000 Nov-Dec;204(6):210-7

Ludwig Boltzmann Institut für Frauengesundheitsforschung, Semmelweis-Frauenklinik Wien.

Background: Decreasing vertical transmission rates of HIV due to highly active antiretroviral therapy regimens faciliate the choice for childbearing in HIV positive women. Recent trends in epidemiology of HIV show increasing incidence of HIV-related gynecologic diseases. These facts implicate the question about the role of gynecologists in primary care of HIV-infected women and furthermore about the use of health services by HIV-infected women. Read More

J Acquir Immune Defic Syndr 2000 Sep;25(1):51-5

Division of General Medicine, Brown University, Providence, Rhode Island 02903, USA.

Objective: Gynecologic disease is common in HIV-infected women. We examine the sociodemographic, clinical, and provider factors associated with the care of women with vaginal symptoms.

Methods: Women enrolled in the HIV Cost and Services Utilization Study (HCSUS), a nationally representative probability sample of HIV-infected adults, were interviewed between January 1996 and April 1997. Read More

Am J Obstet Gynecol 2000 Aug;183(2):347-55

Department of Obstetrics and Gynecology, University of Florida College of Medicine, Pansacola 32513, USA.

Objective: This study was undertaken to compare the frequencies of vaginal infections among human immunodeficiency virus-infected women with those among human immunodeficiency virus-seronegative women.

Study Design: Human immunodeficiency virus-seropositive women attending a comprehensive care center for human immunodeficiency virus disease at the outpatient department of an inner-city hospital in Houston underwent rigorous gynecologic evaluation for sexually transmitted diseases, including evidence of vaginal infections such as bacterial vaginosis, vulvovaginal candidiasis, and trichomonal vaginitis. Demographic information was collected, as was information regarding disease classification and degree of immunosuppression. Read More

Int J STD AIDS 1999 Nov;10(11):735-7

Centre for Epidemiological Research in South Africa, Medical Research Council.

Our objective was to determine the prevalence of HIV infection and disease-specific HIV prevalence among women admitted to the gynaecology service of a district hospital in South Africa over a 3-month period in 1997. This was done with the goal of developing HIV education and counselling services in this setting. HIV status was determined among 196 (96%) of 205 consecutive admissions; 82 (42%) tested HIV positive. Read More

Sex Transm Dis 1999 Sep;26(8):421-5

Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, Atlanta, Georgia 30333, USA.

Objective: To assess the proportion of women with verified treatment after positive screening tests for C. trachomatis infection and to evaluate the duration of time until treatment.

Design: Retrospective cohort analysis linking the date of a positive genital C. Read More

J Nurse Midwifery 1998 Nov-Dec;43(6):502-25

Department of Family and Child Nursing, School of Nursing, University of Washington, Seattle 98195-7262, USA.

Changes in the clinical management of women living with human immunodeficiency virus (HIV) have occurred as a result of significant gains in the scientific knowledge of this retrovirus. As the incidence of HIV/AIDS continues to escalate among female adults and adolescents in the United States, all primary health care providers must anticipate the likelihood of encountering clients with HIV infection. Midwives must be adequately prepared to meet the challenges of managing women with HIV in the early stages of the disease. Read More

J Assoc Nurses AIDS Care 1998 Sep-Oct;9(5):47-52

Yale School of Nursing, New Haven, CT 06536-0740, USA.

To better understand factors associated with symptomatic and asymptomatic vulvovaginal candidiasis, including the role of immune compromise and patient self-report, a cross-sectional analysis of factors associated with the isolation of yeast from vaginal swabs and clinical diagnosis of Candida vaginitis (CV) among 184 HIV-infected women was conducted. Sixty-four (35%) of the women had vaginal swabs positive for yeast. Nineteen (10%) women met the case definition for CV. Read More

J Natl Cancer Inst Monogr 1998 (23):43-9

Department of Gynecologic Oncology, State University of New York-Health Science Center, Brooklyn 11203, USA.

The existence of cervical neoplasia in women with human immunodeficiency virus (HIV) represents one of the most serious challenges in the oncologic care of immunosuppressed patients. While the development of most cancers in the immunosuppressed patient can be attributed solely to immune deficiency, the relationship between squamous cell neoplasia of the cervix and HIV is quite unique because of common sexual behavioral risk factors. Screening strategies in HIV-positive women must take into account the high prevalence of cervical dysplasia in this subgroup as well as the limitations of cytologic screening. Read More

Am J Obstet Gynecol 1998 Jan;178(1 Pt 1):166-70

Department of Obstetrics and Gynecology, State University of New York Health Science Center, Brooklyn 11203, USA.

Objective: Our goal was to determine types of inpatient admissions among human immunodeficiency virus-infected women both before and after the human immunodeficiency virus diagnosis, so that we might outline opportunities for intervention.

Study Design: A total of 292 human immunodeficiency virus-infected women were interviewed about the reproductive history and prior hospitalizations. A reproductive health hospitalization was defined as either an obstetric admission or a gynecologic admission. Read More

Obstet Gynecol Clin North Am 1997 Dec;24(4):855-72

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, USA.

This article reviews the interactions between HIV infection and a variety of gynecologic conditions, including lower genital tract neoplasia, pelvic inflammatory disease, menstrual disorders, sexually transmitted diseases, and vaginitis. Important considerations in choosing a family planning method for women infected with HIV-infected women will respond to standard therapy, but require multiple courses of treatment or use of innovative treatment methods. All HIV-infected women deserve careful evaluation for and treatment of gynecologic diseases. Read More

Proj Inf Perspect 1997 Jul(22):18-9

Medscape Womens Health 1996 Oct;1(10)

Division of Infectious Diseases, Department of Medicine, and Co-director of the Women & Family HIV Centre (Oak Tree Clinic) at British Columbia Women's Hospital, University of British Columbia, Vancouver, Canada.

Since its emergence in 1981, the human immunodeficiency virus (HIV) has been viewed by the Western world as a disease that primarily affected men. Yet in mid 1996, the World Health Organization (WHO) estimated that globally 42% of the 21 million adults living with HIV infection were women. They also reported that the proportion of infected women continues to grow in developed and underdeveloped countries. Read More

Am Fam Physician 1996 Oct;54(5):1541-8, 1554-6

Natividad Medical Center, Salinas, California, USA.

The proportion of women infected with the human immunodeficiency virus (HIV) continues to increase. Over one-half of women acquire the virus through heterosexual contact. The diagnoses that define the acquired immunodeficiency syndrome and the use of antiretroviral therapy are similar in men and women, except in pregnancy. Read More

P N G Med J 1996 Sep;39(3):190-5

Department of Clinical Sciences, Faculty of Medicine, University of Papua New Guinea, Port Moresby, Papua New Guinea.

Thirteen women were discovered to be positive for human immunodeficiency virus (HIV) infection during pregnancy at the Port Moresby General Hospital from 1988 to 1995; of these, eight were diagnosed in the first half of 1995. Risk testing for HIV status is unlikely to discover more than 20% of HIV-positive antenatal patients because risk factors target intravenous drug users and the sexual behaviour of men. Pregnancy does not seem to have a major impact on the progress of HIV disease, but could be detrimental particularly in the later stages of the disease. Read More

Clin Obstet Gynecol 1996 Jun;39(2):333-43

Grady Memorial Hospital, Atlanta, Georgia 30335-3801, USA.

Perinatal transmission and reproductive decisions of HIV-infected women can be categorized in statistical and epidemiological terms. These reports and figures, however, do little to fully explain the complexities of human relationships, life experiences, personal and cultural influences, and situational and environmental variables that impact on the HIV-infected woman regarding reproductive decision-making. It is only with genuine attempts to understand the woman's perspective and the dynamic and unique variables that influence reproductive decision-making, as well as maintaining a non-judgmental and culturally sensitive perspective, can we hope to assist women, and society as a whole, in coming to terms with the complexities of HIV and reproductive decision-making. Read More

Obstet Gynecol 1996 Feb;87(2):195-8

Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Objective: To examine pregnancy rates among women infected with human immunodeficiency virus (HIV).

Methods: We used data from an ongoing survey of medical records of 3915 women who were 15-44 years of age, infected with HIV, and who received care between January 1990 and August 1994 in more than 90 clinics, hospitals, and private practices in 11 United States cities.

Results: At enrollment, 570 (14%) of these women were pregnant. Read More

J Acquir Immune Defic Syndr Hum Retrovirol 1995 Aug;9(4):361-70

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, USA.

Gynecologic disease is commonly encountered in women infected with the human immunodeficiency virus (HIV). The clinical course of cervical intraepithelial neoplasia, invasive cervical cancer, pelvic inflammatory disease, syphilis, and vaginal candidiasis may be altered by HIV infection and may be refractory to standard treatment, especially with increasing degrees of immune suppression. Careful screening for gynecologic disease and vigilant surveillance for treatment failure are important in the care of women infected with HIV. Read More

Int J Gynaecol Obstet 1994 Dec;47(3):273-4

Department of Obstetrics and Gynecology, University of Rochester, NY 14642.

The current state of knowledge regarding the gynecologic care of HIV-infected women is in its infancy. Standard algorithms are not valid. We present an example of the inadequacy of routine surveillance and treatment methods in these patients. Read More

Fam Plann Perspect 1994 Nov-Dec;26(6):264-9

Alan Guttmacher Institute (AGI), Washington, D.C.

To explore the relationship between human immunodeficiency virus (HIV) and AIDS services and reproductive health services, a survey was undertaken in 1994 of 30 health care facilities that are grantees under Title IIIb of the Ryan White Comprehensive AIDS Resource Emergency Act, 19 family planning clinics that offer at least some HIV services, and two family planning agencies that are also grantees under Title IIIb. The Title IIIb providers and the family planning agencies offer similar sets of services, but they tend to view reproductive health and HIV and STD services as distinctly different categories. Eliminating the perceptual distinctions between these services and viewing reproductive health services as key components of HIV and AIDS prevention could result in a more integrated system of helping women with HIV infection or AIDS as well as those at risk of HIV infection. Read More

Clin Infect Dis 1993 Aug;17(2):165-72

Section of HIV, Louisiana State University School of Medicine, New Orleans 70112.

To better understand the clinical manifestations of human immunodeficiency virus (HIV) infection in women in Louisiana, we conducted a retrospective review of the records of HIV-infected women who presented to the largest HIV outpatient clinic in Louisiana as well as to a tertiary care university hospital in New Orleans between January 1987 and December 1991. A total of 224 women were evaluated. Gynecologic examinations revealed that 17. Read More

J Am Board Fam Pract 1993 Jul-Aug;6(4):367-77

Department of Family and Community Medicine, University of California, San Francisco.

Background: Infection with the human immunodeficiency virus (HIV) has emerged as a major health problem for women in the United States. Family physicians can play an important role in the detection and care of HIV-infected women.

Methods: The epidemiology and natural history of HIV infection in women were reviewed. Read More

Int J Gynaecol Obstet 1993 Jun;41(3):307-19

The increasing rate of HIV infection among women presages an important role for providers of health care to women. The need to provide obstetric and gynecologic care to HIV-infected women and to become involved in efforts to control the disease are important issues facing today's obstetrician-gynecologists. Read More

Nurs Outlook 1992 Sep-Oct;40(5):203-6

College of Nursing, Rutgers, State University of New Jersey, Newark.

AIDS 1992 Aug;6(8):849-59

Office of AIDS Surveillance, New York City Department of Health, New York 10013.

Objectives: To define the spectrum of HIV-1-related disease in New York City (NYC) and to determine how the clinical spectrum of illness differs in various populations.

Design And Methods: The medical records of the 2983 HIV-infected individuals who had received care through 1989 at four hospital outpatient clinics and two private physicians' offices were reviewed retrospectively.

Results: Sixty-one per cent of the study patients and 48% of patients seen in 1989 had AIDS. Read More

Nurse Pract 1992 May;17(5):27, 31-4, 37-8 passim

Adult Health Division, Yale University School of Nursing, New Haven, Conn.

The growing epidemic of HIV infection poses a serious threat to women's health in the United States and abroad. In the United States, HIV disproportionately affects African-American and Hispanic-American woman. Primary care providers will be faced with an increasing need to provide counseling and clinical services to these women. Read More