Научный центр проблем здоровья семьи и репродукции, г. Иркутск, Россия Высокоактивная антиретровирусная терапия (АРВТ) увеличила продолжительность жизни людей, живущих с вирусом иммунодефицита человека (ВИЧ) и синдромом приобретенного иммунодефицита (СПИД). Достижения в области научных знаний и, в частности, ведения ВИЧ-инфицированной беременной женщины также привели к снижению риска передачи ВИЧ от матери ребенку. Цель: рассмотреть современные проблемы нарушений гинекологического и репродуктивного здоровья и патофизиологические аспекты этих нарушений у ВИЧ-инфицированных женщин. Материалы и методы. Обзор российских и международных научных публикаций, касающихся вопросов гинекологии, репродуктивного здоровья и ВИЧинфекции из проиндексированных онлайн-журналов и соответствующих веб-сайтов с использованием поиска Pubmed и Google в период с 1999 по май 2019 года. Результаты. В последние годы повышается доля ВИЧ-инфицированных женщин и возрастает роль полового пути передачи инфекции, а также активное вовлечение в эпидемию ВИЧ-инфекции женщин репродуктивного возраста. У ВИЧ-инфицированных беременных, не получавших высокоактивную АРВТ, увеличивается частота акушерских осложнений, родов и неблагоприятных исходов у детей. ВИЧ-инфекция может снижать фертильность женщин на любой стадии заболевания, отмечены нарушения менструального цикла и овуляции, снижение овариального резерва и качества ооцитов. У ВИЧ-инфицированных пациентов регистрируют потерю массы тела и дистрофию, нарушение функции щитовидной железы, надпочечников и гипогонадизм. Нарушения менструальной, овуляторной функции могут происходить по целому ряду причин, которые непосредственно не связаны с их болезнью, а с множественными стрессовыми факторами. ВИЧ-положительная женщина страдает повышенной частотой и тяжестью тазовых инфекций, предраковых и злокачественных поражений шейки матки. Гинекологические, репродуктивные потребности и специфика наблюдения за ВИЧ-положительной женщиной недостаточно оценены, неоптимальны и в значительной степени игнорируются, что может негативно сказаться на качестве жизни и усилиях по борьбе с эпидемией ВИЧ. Ключевые слова: ВИЧ-инфекция, репродуктивное здоровье, гормоны, бесплодие, менструация, половое поведение Конфликт интересов: авторы заявили об отсутствии конфликта интересов. Для цитирования: Лещенко О.Я., Генич Е.В. Репродуктивные нарушения и их патогенетические механизмы у ВИЧ-инфицированных женщин // ВИЧ-инфекция и иммуносупрессии. Background. Highly active antiretroviral therapy (ART) has increased the life expectancy of people living with the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Advances in scientific knowledge and, in particular, in the management of an HIV-infected pregnant woman have also reduced the risk of mother-to-child transmission of HIV. Aims. Consider the current problems of gynecological and reproductive health disorders and the pathophysiological aspects of these disorders in HIV-infected women. Methods. Review of Russian and international scientific publications re...

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Objective. The research of clinical features, reproductive health and sexual disorders with women of childbearing age, involved in HIV epidemic.Materials and methods. Cross-sectional, cohort, clinical sociological research of gynecological pathology and comorbid conditions among 85 women with HIV infection. The results of sociological research by anonymous survey among 50 women and 35 men of reproductive age with HIV infection are presented. The research was held using a questionnaire, based on WHO thematic map-questionnaire (WHO project №88093).Results and discussion. The main group with HIV infection and reproductive disorders contains 27 women (median age 30,8±2,9). The comparison group consisted of 23 women with HIV infection without reproductive disorders (median age 31,4±7,1). The frequency of medical abortion appeared twice as often in the group of HIV-infected women with reproductive disorders. Statistically significant differences in occurrence of chronically related diseases: ENT organs, gastritis/duodenitis, pancreatitis, cystitis, pyelonerphritis, viral hepatitis (В, С), Papilloma Viral Infection in the compared groups has not been identified. The women with HIV infection and reproductive disorders experienced inflammatory disease of pelvic organs, provoked by chlamydia, gonorrhea, trichomoniasis, syphilis twice as often. Statistically significant differences in occurrence of hysteromyoma, chronic cervicitis, chronic endometritis, vulvovaginal candidiasis, cervical intraepithelial neoplasia haven’t been detected. Menstrual function analysis among the women with HIV infection and reproductive disorders identified a considerable predominance of secondary amenorrhea, opsomenorrhea, secondary oligomenorrhea and dysmenorrhea. The women with HIV infection and reproductive disorders experienced hyperprolactinemia syndrome 3 times as often. The men were married more often than the women, had regular sexual intercourse, were not interested in their partners’ pregnancy. The most common method of contraception for women as well as for men was contraception sheath and rejected sexual intercourse. However, 20% and 26% men and women with HIV infection, who had sexual intercourse, didn’t use any methods of contraception. The main reason for both men and women to refuse pregnancy planning was unsatisfactory financial situation and having current HIV infection.Conclusion. Early diagnosis of menstrual disorders, prevention of abortion and sexually transmitted diseases, and also early infertility treatment are necessary for women with HIV infection. Apart from medical care, medical workers should take into account social and psychological needs to help patients with HIV improve their quality of living, including sexual and reproductive health.

Objective: to establish a correlation of the main neuroendocrine and metabolic parameters associated with infertility and to provide a prognostic assessment of reproductive disorders in HIV-infected women, stages 4.Materials and methods. Cross-sectional, cohort, clinical and sociological study of fertility of 83 women of reproductive age with HIV, stages 4.Results. The most significant indicators of lipid peroxidation and neuroendocrine regulation systems have been established in patients with HIV infection and reproductive disorders, which will make it possible to predict these disorders in the future. Decreased ovarian reserve, ovarian steroid function, increased pituitary prolactinergic function are associated with a deficiency of a number of antioxidants (retinol, tocopherol, superoxide dismutase) and the development of oxidative stress with a predominant accumulation of intermediate lipid peroxidation products in HIV-infected women with infertility.Conclusion. The pathogenetically substantiated principle of the correction of antioxidant status is the use of a-tocopherol and retinol preparations and the correction of hormonal levels in HIV-infected women with reproductive disorders.

Background: The increase in the number of HIV-infected women of fertile age, as well as their reproductive plans to have healthy children, was the reason for studying the features of reproductive health disorders and comorbid conditions in women with HIV infection. Methods and Results: Women meeting the inclusion criteria were divided into two groups: Group 1 included 27 HIV-infected women (average age of 30.8±2.9 years) with reproductive disorders; Group 2 included 23 HIV-infected women (average age of 31.4±7.1 years) without reproductive disorders. In study groups, the main route of HIV transmission was sexual contact. When assigning women to a particular category (fertile or infertile), the WHO classification of fertility was used: fertile, presumably fertile, primarily infertile, secondarily infertile, women with unknown fertility. There was a statistically significant difference in the incidence of medical abortion in the HIV-infected women with secondary infertility [14(60.9%)], compared to Group 2 [8(29.6%)] (P=0.026). There were no statistically significant differences in the incidence of chronic co-morbidities (ENT disorders, gastritis/duodenitis, pancreatitis, cystitis, viral hepatitis (B, C), papillomavirus infection) in Groups 1 and 2 (P>0.05). The incidence of pelvic inflammatory diseases was 2 times higher in Group 1 than in Group 2. No statistically significant differences in the incidence of uterine myoma, chronic cervicitis, chronic endometritis, vulvovaginal candidiasis,, and cervical dysplasia were found. A significant prevalence of chronic salpingo-oophoritis, secondary dysmenorrhea, secondary amenorrhea, opsomenorrhea, and secondary oligomenorrhea was detected significantly more frequently in Group 1 than in Group 2. The syndrome of hyperprolactinemia was also 2.6 times more frequent in Group 1 than in Group 2. Reproductive disorders in HIV-infected women were associated with a high incidence of STI combinations (trichomoniasis, gonorrhea, syphilis, chlamydia). Conclusion: Early detection of menstrual dysfunctions, prevention of abortion and sexually transmitted diseases, and timely treatment of infertility, are essential for women living with HIV.