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

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Abstract

Introduction and hypothesis

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

Methods

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).

Results

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.

Conclusions

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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Abbreviations

AIDS:

Acquired immunodeficiency syndrome

HIV:

Human Immunodeficiency Syndrome

HPV:

Human papillomavirus

IQR:

Interquartile range

LUTS:

Lower urinary tract symptoms

OR:

Odds ratio

UDI-6:

Urinary Distress Inventory

UIQ-7:

Urinary Impact Questionnaire

WLWH:

Women living with HIV

References

  1. Cooper J, Annappa M, Quigley A, Dracocardos D, Bondili A, Mallen C (2014) Prevalence of female urinary incontinence and its impact on quality of life in a cluster population in the United Kingdom (UK): a community survey. Prim Health Care Res Dev 1–6. https://doi.org/10.1017/S1463423614000371.

  2. Coyne KS, Sexton CC, Thompson CL, Milsom I, Irwin D, Kopp ZS, et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the epidemiology of LUTS (EpiLUTS) study. BJU Int. 2009;104(3):352–60. https://doi.org/10.1111/j.1464-410X.2009.08427.x.

    Article  PubMed  Google Scholar 

  3. Caruso S, Brescia R, Matarazzo MG, Giunta G, Rapisarda AMC, Cianci A. Effects of urinary incontinence subtypes on Women's sexual function and quality of life. Urology. 2017;108:59–64. https://doi.org/10.1016/j.urology.2017.06.025.

    Article  PubMed  Google Scholar 

  4. Coyne KS, Wein AJ, Tubaro A, Sexton CC, Thompson CL, Kopp ZS, et al. The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU Int. 2009;103(Suppl 3):4–11. https://doi.org/10.1111/j.1464-410X.2009.08371.x.

    Article  PubMed  Google Scholar 

  5. Handa VL, Harvey L, Fox HE, Kjerulff KH. Parity and route of delivery: does cesarean delivery reduce bladder symptoms later in life? Am J Obstet Gynecol. 2004;191(2):463–9. https://doi.org/10.1016/j.ajog.2004.03.031.

    Article  PubMed  Google Scholar 

  6. Kim JH, Sun HY, Park SY, Soh MJ, Kim YJ, Song YS. Association between obesity and lower urinary tract symptoms: propensity score matching study between healthy controls and obese patients seeking bariatric surgery. Surg Obes Relat Dis. 2016;12(8):1585–93. https://doi.org/10.1016/j.soard.2016.04.027.

    Article  PubMed  Google Scholar 

  7. Gyrtrup HJ, Kristiansen VB, Zachariae CO, Krogsgaard K, Colstrup H, Jensen KM. Voiding problems in patients with HIV infection and AIDS. Scand J Urol Nephrol. 1995;29(3):295–8.

    Article  CAS  Google Scholar 

  8. Hermieu JF, Delmas V, Boccon-Gibod L. Micturition disturbances and human immunodeficiency virus infection. J Urol. 1996;156(1):157–9.

    Article  CAS  Google Scholar 

  9. Kopp JB, Miller KD, Mican JA, Feuerstein IM, Vaughan E, Baker C, et al. Crystalluria and urinary tract abnormalities associated with indinavir. Ann Intern Med. 1997;127(2):119–25. https://doi.org/10.7326/0003-4819-127-2-199707150-00004.

    Article  CAS  PubMed  Google Scholar 

  10. Skrzat-Klapaczyńska A, Matłosz B, Bednarska A, Paciorek M, Firląg-Burkacka E, Horban A, et al. Factors associated with urinary tract infections among HIV-1 infected patients. PLoS One. 2018;13(1):e0190564. https://doi.org/10.1371/journal.pone.0190564.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. McClymont E, Lee M, Raboud J, Coutlée F, Walmsley S, Lipsky N, et al. The efficacy of the quadrivalent human papillomavirus vaccine in girls and women living with human immunodeficiency virus. Clin Infect Dis. 2019;68(5):788–94. https://doi.org/10.1093/cid/ciy575.

    Article  CAS  PubMed  Google Scholar 

  12. Money DM, Moses E, Blitz S, Vandriel SM, Lipsky N, Walmsley SL, et al. HIV viral suppression results in higher antibody responses in HIV-positive women vaccinated with the quadrivalent human papillomavirus vaccine. Vaccine. 2016;34(40):4799–806. https://doi.org/10.1016/j.vaccine.2016.08.016.

    Article  CAS  PubMed  Google Scholar 

  13. Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005;193(1):103–13. https://doi.org/10.1016/j.ajog.2004.12.025.

    Article  CAS  PubMed  Google Scholar 

  14. Schneider E, Whitmore S, Glynn KM, Dominguez K, Mitsch A, McKenna MT, et al. Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years—United States, 2008. MMWR Recomm Rep. 2008;57(RR-10):1–12.

    PubMed  Google Scholar 

  15. Gafni-Kane A, Zhou Y, Botros SM. Predictive modeling and threshold scores for care seeking among women with urinary incontinence: the short forms of the pelvic floor distress inventory and urogenital distress inventory. Neurourol Urodyn. 2015. https://doi.org/10.1002/nau.22833.

  16. Breyer BN, Van den Eeden SK, Horberg MA, Eisenberg ML, Deng DY, Smith JF, et al. HIV status is an independent risk factor for reporting lower urinary tract symptoms. J Urol. 2011;185(5):1710–5. https://doi.org/10.1016/j.juro.2010.12.043.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Greene M, Covinsky KE, Valcour V, Miao Y, Madamba J, Lampiris H, et al. Geriatric syndromes in older HIV-infected adults. J Acquir Immune Defic Syndr. 2015;69(2):161–7. https://doi.org/10.1097/QAI.0000000000000556.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Valadares AL, Pinto-Neto AM, Gomes DC, D'Avanzo WC, Moura AS, Costa-Paiva L, et al. Dyspareunia in HIV-positive and HIV-negative middle-aged women: a cross-sectional study. BMJ Open. 2014;4(11):e004974. https://doi.org/10.1136/bmjopen-2014-004974.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Shindel AW, Akhavan A, Sharlip ID. Urologic aspects of HIV infection. Med Clin North Am. 2011;95(1):129–51. https://doi.org/10.1016/j.mcna.2010.08.017.

    Article  PubMed  Google Scholar 

  20. Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6. https://doi.org/10.1001/jama.300.11.1311.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

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. Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada

    Maryse Larouche

  2. St. Mary’s Research Centre, St. Mary’s Hospital, Hayes Pavilion, room 4729, 3830 Lacombe, Montreal, Quebec, H3T 1M5, Canada

    Maryse Larouche

  3. Women’s Health Research Institute, Vancouver, BC, Canada

    Arianne Y. K. Albert, Nancy Lipsky & Deborah M. Money

  4. Department of Infectious Diseases, Toronto General Hospital, Toronto, ON, Canada

    Sharon Walmsley

  5. Department of Infectious Diseases, Women’s College Hospital, Toronto, ON, Canada

    Mona Loutfy

  6. Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada

    Fiona Smaill

  7. Department of Microbiology, Infectious Diseases and Immunology, CHUQ/CHUL, Quebec, QC, Canada

    Sylvie Trottier

  8. Department of Infectious Diseases, SickKids, Toronto, ON, Canada

    Ari Bitnun

  9. Department of Obstetrics and Gynecology & Reproductive Infectious Diseases, St. Michael’s Hospital, Toronto, ON, Canada

    Mark H. Yudin

  10. Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada

    Geoffrey W. Cundiff & Deborah M. Money

Authors
  1. Maryse Larouche
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  2. Arianne Y. K. Albert
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  3. Nancy Lipsky
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  4. Sharon Walmsley
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  5. Mona Loutfy
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  6. Fiona Smaill
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  7. Sylvie Trottier
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  8. Ari Bitnun
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  9. Mark H. Yudin
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  10. Geoffrey W. Cundiff
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  11. Deborah M. Money
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Contributions

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.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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.

    Microsporidiosis

  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). https://doi.org/10.1007/s00192-020-04343-z

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  • DOI: https://doi.org/10.1007/s00192-020-04343-z

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