I have been seeing HIV positive female patients in whom it seems developed ammenorhea /oligomenorrhea when they were commenced on Anti retroviral therapy. Or it is the effect of the HIV virus itself?
It will be good to get further details like how soon after commencing anti retroviral drugs did you notice the amenorrhoea, what was themenstrual pattern before commencement? What types of medications? Age of these patients? What was their baseline CD4 count? And was the count at the point of noticing the amenorrhoea etc
Dear Ikenna,
I think that it is not the effect of the HIV itself and I agree with Cajetan's good comment to get further details. I add also to its comment that prolonged stress leading to a denutrition with weight loss is the predisposing factor to ammenorhea more commonly encountered in HIV patients at the onset of HAART intake. In addition to this, we have also the intake of some medications such as oral corticosteroids, antidepressants, antipsychotics which can lead to disturbances of the hypothalamic-pituitary axis, with resulting irregular bleeding or ammenorhea.
Marcellin.
Dear Ikenna,
You will need to consider a lot of factors responsible for secondary amenorrhea which could be prevalent in HIV patients, such as weight changes, steroid usage and accompanying chronic disease. Since women do get pregnant whilst on antiretroviral drugs it is doubtful if the drugs will be solely responsible for the amenorrhea
Some of the HPA effects are effects of HIV infection so that along with any hormonal therapy the women may be taking could be also considered. But had you seen this article?
https://www.ncbi.nlm.nih.gov/pubmed/27227739
But more problems arise, not too surprisingly, among women not on treatment and worsening with disease progression, as observed in this study--
https://www.ncbi.nlm.nih.gov/pubmed/21058440
Should one suspect an ARV combo in any individual woman as causing such trouble, I guess the next question is whether that clinical situation for her warrants a medication switch and if so to what?
I look forward to hearing more responses.
Dear Ikenna,
From our experience managing a large number of HIV positive women, HIV infection and its complication rather than HAART is the cause of HIV associated amenorrhoea. Most commonly used antiretroviral drugs do not cause amenorrhoea. However if a HIV positive woman is being managed for HIV associated psychiatric conditions, amenorrhoea may result from use of some of the drugs. A combination of factors in HIV positive women causes amenorrhoea - HIV related stress, weight loss, chronic disease, deregulation of HPO axis (often stress related), tuberculous endometritis etc,. In addition all other causes of amenorrhoea in HIV negative women may also occur. Amenorrhoea resulting form HIV often resolves when HAART is initiated, OIs resolves, immune resoration occurs and she gains weight.
From our study- https://www.ncbi.nlm.nih.gov/pubmed/21058440- HIV positive women with severe immunodeficiency, severe weight loss and not on HAART were found to be at the greatest risk of menstrual dysfunction.
I am more likely going to attribute the amenorrhea to the HIV infection itself than the ARVs. Severe infections generally are associated with amenorrhea, and this can be confounded by the psychological worry (a known cause of amenorrhea) that may arise because of the HIV infections.
I appreciate your great responses, they have helped to elucidate things better for me
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