Adverse Effect of HAART on Menstrual Cycle

Effect of HIV

• Overall, HIV infection did not increase the likelihood of having a cycle longer than 40 days (i.e., a longer interval between periods).
• However, HIV positive women with more advanced immunosuppression (CD4 counts less than 200 cells/mm³) were more likely to have long cycles.
• The researchers concluded that HIV serostatus had little effect on menstrual cycle length, and that other factors -- for example, advanced disease, age, race, malnutrition, wasting, and substance use -were more important
• women with HIV were more likely to experience amenorrhea for more than three months and had intervals greater than six weeks between menstrual cycles
• HIV positive women with varying degrees of wasting, 20% overall had experienced amenorrhea. Among the women with amenorrhea, muscle mass was significantly lower, as was the total level of estradiol

Amenorrhea

• women who used HAART had a reduced risk for developing this complication.
• The longer women used HAART, the less likely this problem would occur.

Oligomenorrhea

• This problem was also less likely to occur the longer women used HAART.
• women who used HAART for less than two years still experienced this complication.
• However, once women used HAART for more than two but less than four years, the risk of this problem decreased significantly.
• women who used HAART for more than four years had the least risk of skipping periods.

Intermenstrual bleeding

• Using HAART for less than two years was associated with an increased risk of bleeding between periods.
• However, once women used HAART for two or more years, this risk was reduced.
• Increased CD4+ cell counts were also linked to a decreased risk of intermenstrual bleeding.

Menorrhagia

• The longer women used HAART, the lower their risk of experiencing prolonged periods (lasting more than one week).
• For instance, there was almost no risk of prolonged periods for women who had used HAART for four or more years.
• Women who had used HAART for between two and four years had a slightly increased risk for prolonged periods.
• But for women who had used HAART for less than two years the risk of experiencing menorrhagia was three times greater than normal.
• Also, as CD4+ counts increased, the risk for this problem was reduced.

Points to Consider

• No established side effect profile and reports on effect of HAART on menstrual cycle
• benefit may have been contributed by the overall health of the women improved over time
• study team did not specifically assess any differences among different classes of anti-HIV medications for their effects on menstrual functions. For instance, there are reports that women who use protease inhibitors can sometimes experience heavier bleeding during periods

References:

1. http://www.catie.ca/en/catienews/2006-10-31/impact-hiv-and-haart-menstruation
2. http://www.thebody.com/content/art40771.html
3. http://www.indianjmedsci.org/article.asp?issn=0019-5359;year=2010;volume=64;issue=6;spage=245;epage=252;aulast=Nagpal