Low genitourinary tract risks in women living with the human immunodeficiency virus

Abstract

This review analyzes the clinical associations between specific low genitourinary tract clinical circumstances in perimenopausal and postmenopausal women living with human immunodeficiency virus (WLHIV). Modern antiretroviral therapy (ART) improves survival and reduces opportunistic infections and HIV transmission. Despite appropriate ART, WLHIV may display menstrual dysfunction, risk of early menopause, vaginal microbiome alterations, vaginal dryness, dyspareunia, vasomotor symptoms and low sexual function as compared to women without the infection. They have increased risks of intraepithelial and invasive cervical, vaginal and vulvar cancers. The reduced immunity capacity may also increase the risk of urinary tract infections, side-effects or toxicity of ARTs, and opportunistic infections. Menstrual dysfunction and early menopause may contribute to the early onset of vascular atherosclerosis and plaque formation, and increased osteoporosis risks requiring specific early interventions. On the other hand, the association between being postmenopausal and having a low sexual function is significant and related to low adherence to ART. WLHIV deserve a specific approach to manage different low genitourinary risks and complications related to hormone dysfunction and early menopause.

摘要

这篇综述分析了特定的下泌尿生殖道的临床情况在围绝经期和绝经后妇女与人类免疫缺陷病毒（WLHIV）的临床关联。现代抗逆转录病毒疗法（ART）提高了生存率, 减少了机会性感染和艾滋病毒传播。尽管进行了适当的ART, WLHIV与未感染的女性相比可能显示月经失调、绝经提前风险、阴道微生物组改变、阴道干燥、性交困难、血管舒缩症状和性功能低下。他们增加了上皮内癌和侵袭性宫颈癌、阴道癌和外阴癌的风险。降低免疫力还可能增加尿路感染、ART的副作用或毒性以及机会性感染的风险。月经失调和绝经早期可能导致血管动脉粥样硬化和斑块形成的早期发作, 并增加需要特定的早期干预的骨质疏松症的风险。另一方面, 绝经后和性功能低下之间的关联是显著的, 并且与对ART的低依从性有关。WLHIV值得一种特定的方法来管理不同的下泌尿生殖系统风险和与激素功能障碍和绝经早期相关的并发症。

Keywords:

• Acquired immunodeficiency syndrome
• antiretroviral therapy
• cancer
• genitourinary syndrome
• human immunodeficiency virus
• low urogenital tract
• menopause

Potential conflict of interest

No potential conflict of interest was reported by the authors.

Source of funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.