Monday, November 23, 2015

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

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