Low levels of adherence to antiretroviral therapy in HIV-1-infected women with menstrual disorders

Abstract

We evaluated the prevalence of menstrual disorders in HIV-1-infected women and explored the association between such disorders and adherence to antiretroviral therapy, sexual functioning, and depressive symptoms in a group of HIV-1-infected women aged younger than 46 years and on antiretroviral therapy. Participants were included in a cross-sectional survey between June 2005 and December 2006. Women provided information about their menstrual cycle and adherence in a single visit and responded to the Greene Climacteric Scale, the Massachusetts General Hospital Sexual Functioning Questionnaire and the Beck Depression Inventory. Women with and without menstrual disorders were compared using parametric and nonparametric tests. A multivariate stepwise logistic regression model was developed. The participants were 107 Caucasian women with a median (interquartile range [IQR]) age of 39 years (IQR, 36-42 years) and a median CD4 cell count of 483 cells/mm(3) (IQR, 332-679 cells/mm(3)). The viral load was below 50 copies per milliliter in 76.6% of the women. Sixty-four percent of the women had acquired HIV-1 infection through sexual intercourse. Menstrual disorders, observed in 32% of participants, were more frequent in women with detectable viral loads (p = 0.018). Women with menstrual disorders reported worse adherence (p = 0.005) and more sexual dysfunction (p < 0.05). Sixty-nine percent of the women who attributed their menstrual disorders to the use of antiretrovirals had inadequate adherence. Depressive symptoms were not observed. Vasomotor symptoms (p = 0.004), having a detectable viral load (p = 0.03) and adherence less than 95% (p = 0.02) were predictors of menstrual disorder. A third of the HIV-1-infected women assessed had menstrual disorders that impacted negatively on adherence to therapy and sexual function. The subjective attribution of these irregularities to antiretrovirals seems to affect medication intake, possibly favoring negative clinical consequences.