Strategies to improve the uptake of effective contraception in perinatally HIV-infected adolescents.

OBJECTIVE: To assess strategies to improve safe-sex practices in sexually active female adolescents living with HIV, through linking reproductive health (RH) care with HIV care. METHODS: A single arm, 48-week prospective study was conducted with 77 sexually active adolescents in five sites in Thailand. Guided RH education was carried out through video, brochures and individual counselling. Participants were offered free effective contraception (EC), in addition to a barrier method (dual contraception) versus barrier method only. Changes in EC use were assessed with McNemar's test; predicting factors with logistic regression. RESULTS: Median age was 19 years; 95% were perinatally infected; 30% had been pregnant. All but one showed RH-knowledge improvement after RH education. Individual counselling was most often rated the 'most helpful' educational method. At the screening visit 21% were using dual contraception; 53% a male condom only; 8% EC method only; and 18% were not using any contraceptive method. Dual-contraception use improved with time, reaching 74% at week 48. EC-use at the baseline visit was associated with having ever used EC prior to study entry (P<0.0001), and the study site (P<0.0001). Having ever used EC was associated with a history of pregnancy (P=0.0085) and forced sex (P=0.0386). CONCLUSION: Offering continuous RH care, linked with HIV care, resulted in increased use of dual contraception. Healthcare providers played a significant role in the process. RH education should address the main predictors for EC use by adolescents, including past, personal experience.

Age at menopause and menopause-related symptoms in human immunodeficiency virus-infected Thai women.

OBJECTIVE: There are limited data for age at menopause (AM) and menopause-related symptoms in human immunodeficiency virus (HIV)-infected Asian women. We investigated AM and menopause-related symptoms in HIV-infected Thai women. METHODS: HIV-infected Thai women 40 years or older who did not receive any hormone therapy in the 8-week period preceding the study were enrolled. Participants completed the Menopause-Specific Quality of Life survey for their symptoms in the past 30 days. Menopause was defined as having the last menstrual period more than 1 year ago. Multivariate Cox proportional hazard regression analysis was used to identify factors associated with menopause. RESULTS: Two hundred sixty-eight HIV-infected women were enrolled; their median age was 44.6 (41.8-48.7) years, and the ratio of their Centers for Disease Control and Prevention clinical classifications (A:B:C) was 53%:34%:13%; 95% were using highly active antiretroviral therapy. The median (interquartile range [IQR]) CD4 count was 575 (437-758) cells/µL, and 93% had HIV-RNA of less than 1.7log10 copies/mL. Among the 55 women who had reached menopause, the mean (SD) AM was 47.3 (5.1) years. The mean (SD) AM in our study was earlier than the previous report of 49.5 (3.6) years in non-HIV-infected Thai women (difference, -2.2 y; 95% CI, -3.2 to -1.2, P < 0.01). Postmenopausal women had more symptoms, including night sweats (P = 0.03), change in sexual desire (P = 0.01), and avoiding intimacy (P = 0.01), compared with nonpostmenopausal women. No differences in psychosocial or physical domains between groups were found. Factors associated with menopause were Centers for Disease Control and Prevention clinical classification B or C (hazard ratio, 1.7; 95% CI, 1.0-3.03, P = 0.04), and no sexual act in the past month (hazard ratio, 4.9; 95% CI, 1.5-16.0, P = 0.01). No associations of later age of menarche, parity, marital status, educational level, income, body mass index, CD4 count, and HIV-RNA with menopause were found. CONCLUSIONS: AM in HIV-infected Thai women was 47.3 years, which is significantly earlier than the findings of a previous AM report on non-HIV-infected women. Postmenopausal HIV-infected women had more vasomotor and sexual symptoms. More studies are needed to investigate the cause and appropriate interventions for accelerated menopause in HIV-infected women.

Prevalence of high-risk human papillomavirus infection (HPV) and correlation with postmenopausal hormonal therapy in Thai women aged more than 45 years old.

OBJECTIVE: To determine the prevalence of high-risk HPV infection and to evaluate the association between high-risk HPV infection and hormone replacement therapy in Thai women 45 years old and older. MATERIAL AND METHOD: The present cross-sectional study was performed in 600 women aged 45 years old and older who attended the menopausal clinic of Phramongkutklao Hospital. There were 191 hormone users and 392 non-hormone users. The HPV DNA was studied in cellular residual from liquid-based collection tube and analyzed with a hybrid capture two techniques using a mix of high risk viral RNA probe. RESULTS: The prevalence of high-risk HPV infection was 34 (5.67%) of 600 participants. When divided by status of hormone users, the prevalence of this infection in non-users, past user group, and current user group was 5.36%, 4.96%, and 10.00% respectively There was non-significantly elevated risk among past (adjusted odd ratio (OR) = 0.92, 95% confidence interval (CI) = 0.36-2.34) and current (adjusted OR = 1.96, 95% CI = 0.80-4.81) hormonal users compared to never users. However, women who currently used unopposed estrogen orally had a statistically significant higher risk of high-risk HPV detection (adjusted OR = 9.82, 95% CI = 3.02-31.89). CONCLUSION: The prevalence of high-risk HPV infection in Thai women 45 years old and older was 5.67%. The oral, unopposed estrogen was associated with a higher incidence of high-risk HPV infection, but a small number of hormonal users. Further investigations are needed.

Levels of biochemical bone marker procollagen type I N-propeptide (PINP) in Thai women aged 40-70 years.

OBJECTIVE: To determine reference ranges for serum Procollagen type I N-propeptide (PINP), one of the bone formation markers, in Thai women aged 40-70 years old. MATERIAL AND METHOD: PINP was measured in fasting serum of 300 healthy Thai women who had never been diagnosed as osteoporosis. They were divided into 3 groups by age, 100 per each; the first were menstruating women aged 40-50 years, the second were 51-60 year old menopausal women, and the third were 61-70 year old postmenopausal women. RESULTS: The mean values of PINP with 95% confident interval in groups 1,2,3 were 42.67 (38.74, 46.59), 61.63 (55.94, 67.31) and 60.66 (55.35, 65.96) ng/ml respectively. CONCLUSION: The present study showed PINP levels in Thai women in diferent age and menstrual status. The mean PINP in the postmenopausal group was higher than the premenopausal group, which confirmed postmenopausal women have more bone turnover rate.

Accuracy of fetal heart-rate variability interpretation by obstetricians using the criteria of the National Institute of Child Health and Human Development compared with computer-aided interpretation.

AIM: To evaluate the accuracy of fetal heart rate variability interpretation by obstetricians using the criteria of the National Institute of Child Health and Human Development (NICHD), compared with computer-aided analysis as a gold standard. METHODS: One hundred and fourteen panels of fetal heart-rate tracings derived from electrocardiogram via scalp electrodes obtained from women with high-risk pregnancies during the intrapartum period. The tracings were interpreted using computer analysis and recorded as a gold standard. The same tracings were distributed to six observers: three residents in the third year of training and three faculty members. All observers blindly interpreted the fetal heart-rate variability without the knowledge of the computer analysis. The main outcome measures were: (i) the accuracy of fetal heart-rate variability interpretation by obstetricians using the NICHD criteria compared with computer-aided analysis was presented as a percentage value; and (ii) the agreement of fetal heart-rate variability interpretation between the obstetricians and the computer analysis using the NICHD criteria was presented as a kappa-value. RESULT: When using the computer analysis as a gold standard, the accuracy of fetal heart-rate variability interpretation in the residents group was 81.58%, 86.84% and 82.46%, respectively, with a mean of 83.62%, whereas the accuracy of the faculty members was 79.82%, 67.54% and 79.82%, respectively, with a mean of 75.73%. kappa-values, representing the agreement of interpretation, were 0.70, 0.78 and 0.72, with a mean of 0.73 +/- 0.04 among the residents, and 0.67, 0.50 and 0.68, with a mean of 0.62 +/- 0.10 among the faculty members. Agreements in the two groups were not significantly different (Student's t-test, P=0.14). CONCLUSION: Using the NICHD criteria, the accuracy and agreement of fetal heart-rate variability interpretation in the third-year residents and faculty members are substantial. There was no difference between the groups with regard to the agreement of fetal heart-rate variability interpretation.

Placental thickness in the first half of pregnancy.

PURPOSE: This study was conducted to establish normal values of placental thickness during the first half of pregnancy. METHODS: Normal pregnant women with singleton pregnancies between 8 and 20 weeks of gestation were recruited into the study. All the newborns were normal at birth. Placental thickness was measured perpendicularly through the thickest part of the placenta on transabdominal scans. The placental thickness data were analyzed for mean, standard deviation, 95% confidence interval, and 2.5(th), 5(th), 50(th), 95(th), and 97.5(th) percentile for each week of gestational age. The best-fit mathematical model was derived by regression analysis. RESULTS: The total number of measurements was 333 and the number of measurements for each week of gestational age ranged from 9 to 37. Regression analysis yielded the following linear equation of the relationship: placental thickness (in mm) = gestational age (in weeks) x 1.4-5.6 (r = 0.82). CONCLUSION: We have established a nomogram for placental thickness. This resource may be a useful aid in the early detection of placental abnormalities, such as hydropic placenta secondary to hemoglobin Bart's disease.