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Urinary symptoms and quality of life in women living with HIV: a cross-sectional study

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Introduction and hypothesis

To determine prevalence and quality of life impact of lower urinary tract symptoms (LUTS) in women living with HIV (WLWH).


Cross-sectional urinary questionnaires were included in a multicenter national prospective study of the HPV vaccine in WLWH. Demographic and clinical information was abstracted from the parent study. The Urinary Distress Inventory (UDI-6) and Urinary Impact Questionnaire (UIQ-7) were administered. Wilcoxon rank sum, two-sample chi-square or Fisher’s exact tests were used as appropriate to compare women with UDI-6 score ≥ 25 to those with lower UDI-6 scores on demographic and HIV-related factors. Significant categorical variables were followed up with logistic regression to estimate odds ratios (OR).


One hundred seventy-seven women completed urinary questionnaires (85.5% of cohort). Median age was 44.1 (37.2–50.6). Mean CD4 count was 621 (410–785), and 132 women (74.6%) were virologically suppressed. Median UDI-6 score was 4.2 (0–25). Fifty-one women (28.8%) had a UIQ-7 score > 0. Among those with a UDI-6 score of at least 25, median UIQ-7 was 9.5 (0–47.6). UDI-6 ≥ 25 was significantly associated with increasing age, higher BMI, Canada as country of origin, peri-/postmenopausal status (OR 3.37, 95% CI = 1.71 to 6.75) and being parous (OR 2.92, 95% CI = 1.27 to 7.59) (all p < 0.05). HIV-related factors were not associated with UDI-6 ≥ 25.


LUTS were common, but we did not demonstrate a negative impact on quality of life in this sample of WLWH. Large comparative studies are needed to determine whether HIV is a risk factor for bothersome LUTS in women.

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Acquired immunodeficiency syndrome


Human Immunodeficiency Syndrome


Human papillomavirus


Interquartile range


Lower urinary tract symptoms


Odds ratio


Urinary Distress Inventory


Urinary Impact Questionnaire


Women living with HIV


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Work was supported by the Canadian Institutes for Health Research (CIHR) (funding reference number: MOP 136784); CIHR Canadian HIV Trials Network (CTN 236); Reseau FRSQ SIDA-MI supported quality control of the linear array; Chair in Biostatistics from the Ontario HIV Treatment Network to J.R.; and in-kind contribution of vaccine and HPV antibody analysis from Merck Canada Inc. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck Canada Inc. We would also like to acknowledge Sandra Blitz and Janet Raboud for doing the initial statistical analysis for the poster presentation of this project as well as Drs. Jorge Martinez-Cajas, Wendy Wobeser, Sarah Stone, Jeff Cohen and Marina Klein for helping to recruit participants for this project. Finally, this project was made possible by the HPV in HIV study group.

Author information

Authors and Affiliations



1. Larouche M: Original idea, design of study methods, manuscript writing.

2. Albert AYK: Data analysis, manuscript editing.

3. Lipsky N: Coordination between authors, contribution to study design, data analysis and manuscript editing.

4. Walmsley S: Parent study design and management, patient recruitment, manuscript editing.

5. Loutfy M: Parent study design and management, patient recruitment, manuscript editing.

6. Smaill F: Parent study design and management, patient recruitment, manuscript editing.

7. Trottier S: Parent study design and management, patient recruitment, manuscript editing.

8.Bitnun A: Parent study design and management, patient recruitment, manuscript editing.

9. Yudin MH: Parent study design and management, patient recruitment, manuscript editing.

10. Cundiff GW: Contribution to study design, manuscript editing.

11. Money DM: Study design, parent study design and management, patient recruitment, manuscript editing.

Corresponding author

Correspondence to Maryse Larouche.

Ethics declarations

Disclosure statement

A Albert, N Lipsky and Dr. DM Money report research grants from the Canadian Institutes for Health Research (CIHR). Dr. GW Cundiff is the immediate past president of the Americal Urogynecologic Society. Dr. S Trottier reports grants from GSK, Merck, ViiV, AbbVie, Janssen, Amgen and Pfizer outside of the submitted work. Dr. S Walmsley reports serving on advisory boards, lectures, meetings, symposiums and clinical trials with GSK, ViiV, Merck, Gilead and Janssen. Merck provided HPV vaccines in kind, and HPV serologies were conducted in their laboratories at no cost for the parent study, but this was an investigator driven protocol. Drs. A Bitnun, M Larouche, M Loutfy, F Smaill and MH Yudin have nothing to disclose.

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Publisher’s note

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Institution where work was performed

Multicenter Canadian Study with the principal investigator (Dr. Deborah Money) based in Vancouver (BC). Other study sites included Toronto (ON), Hamilton (ON), Kingston (ON), Ottawa (ON), Windsor (ON), Montreal (QC) and Quebec (QC)

Appendix I: HIV-related conditions

Appendix I: HIV-related conditions

  1. 1.

    Seborrheic dermatitis

  2. 2.

    Persistent generalized lymphadenopathy > 1 month

  3. 3.

    Fever > 38.5ºC or 101.3ºF, otherwise undiagnosed

  4. 4.

    Idiopathic thrombocytopenic purpura (ITP)

  5. 5.

    Oral thrush (candida infection)

  6. 6.

    Oral hairy leukoplakia

  7. 7.


  8. 8.

    Shingles (herpes zoster)

  9. 9.

    Diarrhea (otherwise undiagnosed) > 1 month

  10. 10.

    Cryptosporidiosis (with diarrhea)

  11. 11.

    Peripheral neuropathy (not drug related)

  12. 12.

    Peripheral neuropathy (unknown)

  13. 13.

    Cervical dysplasia or cervical intraepithelial neoplasia

  14. 14.

    Candida (yeast) vaginitis - persistent

  15. 15.

    Pelvic inflammatory disease (PID)

  16. 16.

    Lymphocytic interstitial pneumonitis (LIP)

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Larouche, M., Albert, A.Y.K., Lipsky, N. et al. Urinary symptoms and quality of life in women living with HIV: a cross-sectional study. Int Urogynecol J 32, 353–358 (2021).

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