Overweight, Obesity, and Neuropsychological Performance: Results From the Women’s Interagency HIV Study

Conflicting associations of body mass index (BMI) and waist circumference (WC) with neuropsychological performance (NP) are observed in the general population and among people living with HIV. We examined BMI and WC in middle-aged women living with HIV (WLWH) and without HIV (HIV-) in relation to 10-year trajectories of NP in the Women’s Interagency HIV Study (WIHS). NP assessments occurred biennially from 2009-2019. Demographically-adjusted T-scores were calculated for six NP domains: learning, memory, executive function, processing speed, attention and working memory, and motor function. Multivariable linear models stratified by HIV serostatus examined whether baseline (2009) BMI and WC were associated with NP domains - 1) cross-sectionally and 2) longitudinally over 10 years. The sample included 432 WLWH and 367 HIV- women, >40 years old. Most women (73%) were overweight (BMI=25-29.9kg/m2) or obese (BMI=>30kg/m2). Among WLWH, 28% were overweight, 45% obese; among HIV- women, 26% were overweight; 56% obese. Cross-sectionally at baseline, WLWH who were overweight versus normal weight (BMI=18.5-24.9kg/m2), performed worse on executive function, processing speed, and motor function (all p<0.05). HIV- women who were overweight versus normal weight performed worse on memory, learning, executive function, processing speed and motor function (all p<0.05). Baseline BMI and WC were not associated with worsening NP domains in this younger, primarily overweight and obese sample of WLWH or HIV- women (all p>0.05).Future follow-up of these women will enhance understanding of the age when total and/or central obesity may influence NP trajectories and health of the aging brain.

HPV Type Distribution in HIV Positive and Negative Women With or Without Cervical Dysplasia or Cancer in East Africa

BackgroundWomen living with HIV in sub-Saharan Africa are at increased risk to develop cervical cancer (CC), which is caused by persistent infection with 13 oncogenic human papilloma viruses (HR-HPVs). It is important to accurately identify and target HIV-positive women at highest risk to develop CC for early therapeutic intervention.MethodsA total of 2,134 HIV+ and HIV− women from South-West Tanzania were prospectively screened for cervical cancer and precancerous lesions. Women with cervical cancer (n=236), high- and low-grade squamous intraepithelial lesions (HSIL: n=68, LSIL: n=74), and without lesion (n=426) underwent high-resolution HPV genotyping.ResultsEighty percent of women who were diagnosed with HSIL or LSIL were living with HIV. Any lesion, young age, HIV status, and depleted CD4 T cell counts were independent risk factors for HPV infections, which were predominantly caused by HR-HPV types. While multiple HR-HPV type infections were predominant in HIV+ women with HSIL, single-type infections predominated in HIV+ CC cases (p=0.0006). HPV16, 18, and 45 accounted for 85% (68/80) and 75% (82/110) of HIV+ and HIV− CC cases, respectively. Of note, HPV35, the most frequent HPV type in HSIL-positive women living with HIV, was rarely detected as a single-type infection in HSIL and cancer cases.ConclusionHPV16, 18, and 45 should receive special attention for molecular diagnostic algorithms during CC prevention programs for HIV+ women from sub-Saharan Africa. HPV35 may have a high potential to induce HSIL in women living with HIV, but less potential to cause cervical cancer in single-type infections.

Changes in the Proteome in the Development of Chronic Human Papillomavirus Infection—A Prospective Study in HIV Positive and HIV Negative Rwandan Women

Background: Effects on the proteome when a high risk (HR)-HPV infection occurs, when it is cleared and when it becomes chronic were investigated. Moreover, biomarker panels that could identify cervical risk lesions were assessed. Methods: Cytology, HPV screening and proteomics were performed on cervical samples from Rwandan HIV+ and HIV- women at baseline, at 9 months, at 18 months and at 24 months. Biological pathways were identified using the String database. Results: The most significantly affected pathway when an incident HR-HPV infection occurred was neutrophil degranulation, and vesicle-mediated transport was the most significantly affected pathway when an HR-HPV infection was cleared; protein insertion into membrane in chronic HR-HPV lesions and in lesions where HR-HPVs were cleared were compared; and cellular catabolic process in high-grade lesions was compared to that in negative lesions. A four-biomarker panel (EIF1; BLOC1S5; LIMCH1; SGTA) was identified, which was able to distinguish chronic HR-HPV lesions from cleared HR-HPV/negative lesions (sensitivity 100% and specificity 91%). Another four-biomarker panel (ERH; IGKV2-30; TMEM97; DNAJA4) was identified, which was able to distinguish high-grade lesions from low-grade/negative lesions (sensitivity 100% and specificity 81%). Conclusions: We have identified the biological pathways triggered in HR-HPV infection, when HR-HPV becomes chronic and when cervical risk lesions develop. Moreover, we have identified potential biomarkers that may help to identify women with cervical risk lesions.

Behavioral effects of different contraceptive methods and HIV acquisition: an ancillary study of the ECHO randomized trial

Background The ECHO trial randomised 7829 women to depot medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (IUD) and the levonorgestrel (LNG) implant (1:1:1) and found no clear difference in HIV incidence between these three groups. We have previously hypothesized that oligo-amenorrhoea induced by DMPA-IM may have a protective effect on HIV acquisition. The aim of this ancillary study was to assess the effects of DMPA-IM, the IUD and the LNG implant on menstrual symptoms and sexual behavior and to correlate these with HIV acquisition. Methods At the Effective Care Research Unit (ECRU) in South Africa, of 615 women already randomised to DMPA-IM, the copper IUD and the LNG implant (1:1:1) 552 agreed to participate. Participants completed a 28-day symptom and behavior diary following their one-month ECHO trial visit and returning it at their 3-month follow-up visit. HIV acquisition data were retrieved from ECHO trial records. Results Of 552 women enrolled on the ancillary study, 390 (70.6%) completed their daily diary; 130, 133, and 127 received DMPA-IM, IUD, and LNG implant, respectively. Thirty-three (5.9%) of these women acquired HIV. Women on the progestin-only contraceptives were more likely to experience amenorrhoea, as expected, and were less likely to have intra-menstrual coitus than IUD users (p < 0.001 for DMPA-IM vs IUD and p = 0.002 for implant vs IUD). Overall coital frequency was highest and condom usage lowest among DMPA-IM users. Intra-menstrual coitus correlated positively, and duration of menstruation correlated negatively, with HIV acquisition, although these effects were not statistically significant (p = 0.09 and p = 0.079, respectively). Conclusions Findings support the hypothesis that oligo-amenorrhoea and the associated reduced intra-menstrual coitus may mitigate the potential for an increased biological risk of HIV acquisition with DMPA-IM but more evidence is needed. Study registration number PACTR201706001651380

Effects of HIV Status and History of Pregnancy Termination on Trends of Family Planning Knowledge among Women Living in Nine Fragile Countries

Background: To decrease the proportion of women in fragile or conflict-affected situations (FCS) that need, but are not using modern contraception, the global health community must better understand family planning (FP) knowledge gaps; and elucidate which subgroups of women are, and are not, effectively being reached with FP information. This study investigated whether women with notable sexual and reproductive health histories that put them at risk for future pregnancy complications, namely HIV+ women and women with history of terminated pregnancy (HTP), would possess more complete FP knowledge and/or recall being given FP information more readily than HIV- women and women with no HTP (NHTP), respectively. Methods: Knowledge of several contraceptive methods, and the prevalence of women who recalled being given FP information at a healthcare visit, or via TV, radio, or periodical were estimated across HIV, HTP, and country subgroups. HIV+ and HTP status were major predictors in multivariate logistic regressions analyzing the odds of knowing a specified method of contraception or of recalling being given FP information via the modes considered. Results: HIV+ as opposed to HIV- women showed significantly higher odds of knowing about the pill (p=0.001), IUD (p<0.001), injectables (p=0.005), male condoms (p<0.001), female condoms (p<0.001), and implants (p<0.001); but not female or male sterilization. HIV+ women demonstrated higher odds of recalling being given FP information at a health visit (p=0.001), whereas HTP women did not. HTP women showed higher odds (p<0.001) of knowing each modern method of FP with the exception of male sterilization and of recalling TV (p=0.01) and radio (p<0.001) FP messages. Conclusions: Notable findings were the higher FP awareness among HIV+ and HTP women, and the observation that HIV+ women were seemingly provided FP information more readily at healthcare visits than were HTP women, despite their similar risk profiles concerning future pregnancies. Subsequent studies may elucidate why these patterns were observed and indicate which other diagnostic groups are effectively being reached with FP education, and which are not. Understanding trends and predictors of FP knowledge can help practitioners better target FP counseling efforts in FCS toward knowledge gaps and their causes.

Penggunaan Kontrasepsi pada Perempuan dengan HIV di Dunia

Background: HIV infection is a public health problem. In 2019, more than 38 million people were living with HIV, and more than 1.7 million people contracted HIV. On the other hand, it was reported that infant morbidity and mortality remained high, with more than 160,000 infants contracting HIV and more than 100,000 dying from AIDS-related causes. Increased access and improved service programs to control HIV transmission from mother to child are in line with the increasing number of pregnant women with HIV. Women with HIV and their partners need to plan carefully before deciding to have children. Women living with HIV and their partners need to take advantage of services that provide information and contraceptive tools to prevent unplanned pregnancies. The study aimed to understand how HIV-infected women chose contraceptives.Method: Search for articles with a systematic review using four databases consisting of Pubmed, Science Direct, Sage, and Emerald Insight with a publication range of 2017-2020. The keywords used were contraceptive use AND HIV women. The inclusion criteria used were women with HIV aged 15-49 years and used a cross-sectional design.Results: The findings indicated that injections, condoms, and implants were the most common methods of contraception used by women with HIV. Motivation for contraceptive use in women with HIV is influenced by age, marital status, knowledge, number of children, education, previous history of contraceptive use, history of childbirth, lack of fertility desires, income, residence, CD4 count, child's HIV status and partner's HIV status.

Effects of HIV status and history of pregnancy termination on trends of family planning knowledge among women living in nine fragile countries

Background: To decrease the proportion of women in fragile or conflict-affected situations (FCS) that need, but are not using modern contraception, the global health community must better understand family planning (FP) knowledge gaps; and elucidate which subgroups of women are, and are not, effectively being reached with FP information. This study investigated whether women with notable sexual and reproductive health histories that put them at risk for future pregnancy complications, namely HIV+ women and women with history of terminated pregnancy (HTP), would possess more complete FP knowledge and/or recall being given FP information more readily than HIV- women and women with no HTP (NHTP), respectively. Methods: Knowledge of several contraceptive methods, and the prevalence of women who recalled being given FP information at a healthcare visit, or via TV, radio, or periodical were estimated across HIV, HTP, and country subgroups. HIV+ and HTP status were major predictors in multivariate logistic regressions analyzing the odds of knowing a specified method of contraception or of recalling being given FP information via the modes considered. Results: HIV+ as opposed to HIV- women showed significantly higher odds of knowing about the pill (p=0.001), IUD (p<0.001), injectables (p=0.005), male condoms (p<0.001), female condoms (p<0.001), and implants (p<0.001); but not female or male sterilization. HIV+ women demonstrated higher odds of recalling being given FP information at a health visit (p=0.001), whereas HTP women did not. HTP women showed higher odds (p<0.001) of knowing each modern method of FP with the exception of male sterilization and of recalling TV (p=0.01) and radio (p<0.001) FP messages. Conclusions: Notable findings were the higher FP awareness among HIV+ and HTP women, and the observation that HIV+ women were seemingly provided FP information more readily at healthcare visits than were HTP women, despite their similar risk profiles concerning future pregnancies. Subsequent studies may elucidate why these patterns were observed and indicate which other diagnostic groups are effectively being reached with FP education, and which are not. Understanding trends and predictors of FP knowledge can help practitioners better target FP counseling efforts in FCS toward knowledge gaps and their causes.

Effects of HIV status and history of pregnancy termination on trends of family planning knowledge among women in nine fragile and conflict-affected countries

Background To decrease the proportion of women in fragile and conflict-affected situations (FCS) that need, but are not using modern contraception, the global health community must better understand family planning (FP) knowledge gaps; and elucidate which subgroups of women are, and are not, effectively being reached with FP information. This study investigated whether women with notable sexual and reproductive health histories that put them at risk for future pregnancy complications, namely HIV + women and women with history of terminated pregnancy (HTP), would possess more complete FP knowledge and/or recall being given FP information more readily than HIV- women and women with no HTP (NHTP), respectively. Methods Knowledge of several contraceptive methods, and the prevalence of women who recalled being given FP information at a healthcare visit, or via TV, radio, or periodical were estimated across HIV, HTP, and country subgroups. HIV + and HTP status were major predictors in multivariate logistic regressions analyzing the odds of knowing a specified method of contraception or of recalling being given FP information via the modes considered. Results HIV + as opposed to HIV- women showed significantly higher odds of knowing about the pill (p = 0.001), IUD (p < 0.001), injectables (p = 0.005), male condoms (p < 0.001), female condoms (p < 0.001), and implants (p < 0.001); but not female or male sterilization. HIV + women demonstrated higher odds of recalling being given FP information at a health visit (p = 0.001), whereas HTP women did not. HTP women showed higher odds (p < 0.001) of knowing each modern method of FP with the exception of male sterilization and of recalling TV (p = 0.01) and radio (p < 0.001) FP messages. Conclusions Notable findings were the higher FP awareness among HIV + and HTP women, and the observation that HIV + women were seemingly provided FP information more readily at healthcare visits than were HTP women, despite their similar risk profiles concerning future pregnancies. Subsequent studies may elucidate why these patterns were observed and indicate which other diagnostic groups are effectively being reached with FP education, and which are not. Understanding trends and predictors of FP knowledge can help practitioners better target FP counseling efforts in FCS toward knowledge gaps and their causes.

Phenomenology: The Experience of HIV/AIDS Mothers in Self Disclosure to Their Children in Yogyakarta

In Indonesia, there is 150,296 people with HIV AIDS. The prevention efforts is increased by awareness of the sufferer’s. They can do self- disclosure about their HIV status with the family. However, mothers feel afraid to tell their children because of the stigma. They afraid their children will leak their status to others, or become depressed. Whereas the openness of status has a positive impact on mothers, such as providing social support and increasing mother's motivation in caring of their children. The study aimed to determine the experiences of mothers with HIV in self-disclosure to children in Yogyakarta. This study used qualitative research with an interpretive phenomenological approach. Data analysis using Interpretative Phenomenology Analysis. The data collection technique used semi-structured interviews. The sampling technique used purposive sampling with the inclusion criteria: HIV women with 26-45 years and already having children. The number of participants was 5 participants in Yogyakarta. This research got 5 themes to achieve the research objectives. These themes were (1) Feeling "guilty" of children; (2) Trying to rise of life; (3) Trying to let go of the burdens life; (4) Disappointed caused by frightened; (5) Relief of being children acceptance. Self-disclosure is important because it can reduce the burden on clients of people living with HIV AIDS (PLWHA). Self-disclosure to children may increase motivation to live through the ARV treatment. Therefore, the main theme emerged was releasing one's burdens to rise in life

HIV stigma, psychological distress and social support and their relationship to fertility intentions amongst HIV positive (HIV+) women

The current study examined the relationship of demographic and psychological predictors to fertility intentions in HIV+ women in Ontario. 326 HIV+ women between the ages of 18 and 52 were recruited through 28 AIDS service organizations, 8 HIV clinics and 2 community health centres across the province. 58.6% of the sample intended to become pregnant. African ethnicity, living in Toronto, high social support for having a child, and high perceived HIV stigma were associated with higher fertility intentions. Higher age, and European, Canadian and British ethnicity were all associated with lower fertility intentions. No moderation effects were found in multiple regression analyses, but main effects were found for African ethnicity, lower age, living in Toronto, high perceived HIV stigma and high social support for having a child. The majority of the sample intended to become pregnant, suggesting the need for effective health care support for HIV+ women in Ontario.