Uptake of medical interventions in women with HIV infection in Britain and Ireland. Study Group for the MRC Collaborative Study of HIV Infection in Women.

OBJECTIVE: To determine the uptake of medical interventions amongst women known to be HIV positive and in contact with service providers. SUBJECTS: 400 HIV positive women from 15 STD/HIV clinics in Britain and Ireland recruited to the MRC collaborative study of HIV infection in women between June 1992 and August 1994. METHODS: Data obtained prospectively through direct questioning of all women by a physician or research nurse and review of medical and laboratory records. Data recorded on standardised forms and analysed centrally. RESULTS: Nearly one quarter (24%) of women with an AIDS diagnosis had never received Pneumocystis carinii pneumonia prophylaxis, and 24% had never received any antiretroviral therapy. Fewer than two-thirds of black African women had had a chest radiograph. Only one woman had received Pneumovax and only 4% of women had ever taken part in a clinical trial. CONCLUSIONS: A substantial proportion of women with HIV infection did not receive interventions of proven benefit, and participation in clinical trials was very uncommon. The reasons for such poor uptake should be explored among both health care workers and women with HIV infection.

Ethnic differences in women with HIV infection in Britain and Ireland. The study group for the mrc collaborative study of HIV infection in women.

OBJECTIVE: To examine ethnic differences in the socio-epidemiological and clinical characteristics of a cohort of women with HIV infection in Britain and Ireland. DESIGN AND METHODS: Analysis of baseline data (ethnic group, sexual history, likely route of HIV infection, reasons for HIV testing and first AIDS-defining disease) from 400 women with HIV infection recruited into a cohort study from 15 genitourinary medicine/HIV clinics in Britain and Ireland. RESULTS: Sixty-five per cent of women were white and 29% black African. Their median number of lifetime sexual partners was seven and three, respectively (P < 0.001). Ninety-three per cent of black African and 43% of white women were probably infected through sexual intercourse. Injecting drug use was the most likely route of infection in 55% of white women, but none of the black African women. Perceived risk (33%) or investigation of symptoms (26%) were the most common reasons for HIV testing. Seven per cent of white women and 16% of black African women (P < 0.001) had AIDS when HIV infection was diagnosed. The distribution of first AIDS-defining diagnoses differed (P = 0.001) by ethnic group. For white women, the most common disease was Pneumocystis carinii pneumonia; for black African women it was pulmonary tuberculosis. CONCLUSION: There are important differences between black African and white women in sexual history and route of transmission, disease stage at diagnosis and pattern of AIDS-defining diseases.

Unexplained infertility--the value of Pergonal superovulation combined with intrauterine insemination.

Sixty-two women with unexplained infertility were studied. Fifteen (group 1) had timed intrauterine insemination (IUI), 25 (group 2) were treated by Pergonal (Serono Laboratories, Ltd., Welwyn Garden City, England) superovulation, and 22 (group 3) underwent Pergonal superovulation combined with IUI. Where Pergonal treatment was followed by insemination, a significantly greater pregnancy rate per cycle (P less than 0.05) was achieved, whether this group of patients was compared with those treated by IUI alone or with those treated with Pergonal alone. Moreover, the pregnancy rate in group 3 was comparable to that reported following gamete intrafallopian transfer (GIFT). The authors therefore suggest this form of treatment for patients with unexplained infertility prior to their referral to the more invasive procedure of GIFT.