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Influence of human immunodeficiency virus infection on pelvic
inflammatory disease.
Obstetrics & Gynecology 2000;95(4):525-534.
Irwin KL, Moorman AC, O'Sullivan MJ, Sperling R, Koestler ME, Soto I, Rice
R, Brodman M, Yasin S, Droese A, Zhang D, Schwartz DA, Byers RH, for the PID-HIV
Infection Study Group.
Abstract
Objective: To examine the influence of human immunodeficiency virus (HIV) infection on clinical and microbiologic characteristics of pelvic inflammatory disease (PID).
Methods: Forty-four HIV-infected women and 163 HIV noninfected women diagnosed
with PID by standard case definition were evaluated by using clinical severity
scores, transabdominal sonograms, and endometrial biopsies. After testing
for bacterial infections, patients were prescribed antibiotics as recommended
by the Centers for Disease Control and Prevention (CDC).
Results: Symptoms of PID and analgesic use before enrollment did not differ
by HIV serostatus. More HIV-infected women had received antibiotics before
enrollment
(40.9% versus 27.2%, P = .08), a factor associated with milder signs
regardless of serostatus. More HIV-infected women had sonographically diagnosed
adnexal
masses at enrollment (45.8% versus 27.1%, P = .08), a difference that
yielded higher median severity scores (17.5 of 42 points versus 15 of 42 points,
P
= .07). However, those differences were not significant at the P < .05 level. Mycoplasma (50% versus 22%, P < .05) and streptococcus species (34% versus 17%, P < .05) were isolated more commonly from biopsies of HIV-infected women. Within 30 days after enrollment, HIV-infected women generally responded as well to therapy as HIV-noninfected women did, regardless of initial CD4 T-lymphocyte percentage.
Conclusion: Among women with acute PID, HIV infection was associated with
more sonographically diagnosed adnexal masses. Clinical response to CDC-recommended
antibiotics did not differ appreciably by serostatus. Mycoplasmas and streptococci
were isolated more commonly from HIV-infected women, but those organisms also
might be associated with PID in immunocompetent women.