Gynecological diseases and reproductive function of women infected with the human immunodeficiency virus who applied for assisted reproductive technologies

• Elena V. Mityurina
• Svetlana G. Perminova
• Igor I. Baranov

Abstract

The aim of the study was to investigate the structure of gynecological diseases and reproductive history in patients with HIV infection who applied for assisted reproductive technologies.

Material and methods. A prospective clinical study was conducted with the participation of 432 patients who applied for an in vitro fertilization (IVF) program. The main group consisted of 214 women with HIV infection, the control group – 218 patients with HIV-negative status.

Results. The 3^rd subclinical stage of HIV infection prevailed (59.8%), the median duration of the disease was 9.8 (5.7; 12.4) years, the duration of antiretroviral therapy (ART) was 4.5 (2.4; 8) years. Patients with HIV infection were significantly more likely to have induced abortions compared with women in the control group (37.9 and 12.8%; p<0.0001). The frequency of early reproductive losses (17.8 and 15.6%; p=0.547) and live births (16.4 and 10.6%; p=0.077) were comparable between groups, and tubal pregnancy was more often observed in the study group (22.4 and 13.7%; p=0.041). Spontaneous termination in late pregnancy was significantly more common in HIV-infected patients compared with the control group (4.7 and 0.9%; p=0.018). In addition, 1.4% (3 out of 214) of observations in HIV-infected women had antenatal fetal death during full-term pregnancy. In patients with HIV infection, compared with women without HIV infection, urogenital chlamydia (6.5 and 1.9%; p<0.0001), syphilis (5.6 and 0.9%; p<0.0001) and human papillomavirus (HPV) of a high oncogenic type (8.8 and 3.6%; p=0.048) were significantly more common. Cervical epithelial lesions of the HSIL type (3.7%) and cervical cancer (2.3%) were detected only in HIV-infected patients. Purulent-inflammatory diseases of the uterine appendages were observed mainly in the main study group (5.1 and 0.9%; p=0.01), the prevalence of uterine fibroids (15.9 and 11%; p=0.137) and external genital endometriosis (8.4 and 9.6%; p=0.546) had no statistically significant differences between the groups. The most frequently detected pathology during hysteroscopy was endometrial polyp, which occurred in 15.8% of cases in patients with HIV infection and in 16.4% (p=0.903) of cases in women of the control group. Endometrial hyperplasia (1.8 and 2.7%; p=0.475) and chronic endometritis (7 and 5.9%; p=0.759) were observed equally often in both groups, and intrauterine synechia (1.4%) and endometrial adenocarcinoma (0.46%) – only in HIV-infected patients. The duration of infertility in the main study group had a very weak positive correlation with the “experience” of HIV infection (r=0.149; p=0.042) and did not depend on the duration of ART (r=0.087; p=0.248). In both groups, tubal peritoneal factor prevailed (48.1 and 44.2%; p=0.141); the prevalence of male infertility was 22% (47/214) in the main group and 28.1% (61/218; p=0.141) in the control group of the study. In 11.7% (25/214) of cases in the main group and in 18.4% (40/218) in the control group, the combined factor of infertility was an indication for the IVF program. Anovulation was detected in 5 of 214 (2.3%) patients with HIV infection and in 2 of 218 (0.9%) women without HIV infection. The cause of infertility was not established in 8.4% (18/214) of cases in the main group and in 8.3% (18/218) of cases in the control group. In 17 out of 214 (7.9%) HIV-infected patients, there was no infertility, and therefore, the IVF program was carried out according to epidemiological indications.

Conclusion. HIV infection in a woman should be considered as a factor that negatively affects the state of the reproductive system. In this regard, care for women living with HIV should take into account their desire to have children and conduct earlier fertility assessments.

Keywords:human immunodeficiency virus; in vitro fertilization; assisted reproductive technologies; pregnancy; fertility

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