Kerr-Layton J A, Stamm C A, Peterson L S, McGregor J A
Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver Health Medical Center, CO, USA.
Infect Dis Obstet Gynecol. 1998;6(4):186-90. doi: 10.1002/(SICI)1098-0997(1998)6:4<186::AID-IDOG9>3.0.CO;2-M.
Abnormal uterine bleeding is a common and troublesome problem in human immunodeficiency virus (HIV)-infected women. We sought to evaluate endometrial pathology among HIV-infected women requiring hysterectomy to explore if endometritis may be common among these patients.
We performed a retrospective analysis of uterine pathology specimens obtained from HIV-infected and control patients requiring hysterectomy in two urban hospitals between 1988 and 1997 matched for age, surgical indication, and history of gonadotropin-releasing hormone (GnRH) use. Cases were evaluated for the presence of plasma cells and assigned a grade between 0 and 3.
Indications included cervical dysplasia (4), carcinoma in situ (2), abnormal uterine bleeding (3), and adnexal mass (3). Some degree of abnormal uterine bleeding occurred in all cases. Plasma cell endometritis was twice as common in HIV-infected women compared to HIV-negative specimens (11/11 versus 11/22) (P < 0.05). Plasma cell endometritis was also of a higher grade in specimens from HIV-infected women than in controls (P = 0.001).
Chronic endometritis was common and of a higher grade among HIV-infected women requiring hysterectomy in our series. Diagnosis and treatment of endometritis should be considered in HIV-infected women with uterine bleeding and/or tenderness. We speculate that antiretroviral and/or antimicrobial treatment for endometritis may effectively treat endometritis and eliminate the need for surgery in some HIV-infected women. We suggest that consideration and treatment of endometritis in HIV-1 infected women being evaluated for possible hysterectomy has the potential to reduce costs and morbidity for patients and providers who may be exposed during surgical procedures.
子宫异常出血在感染人类免疫缺陷病毒（HIV）的女性中是一个常见且棘手的问题。我们试图评估需要进行子宫切除术的HIV感染女性的子宫内膜病理情况，以探究子宫内膜炎在这些患者中是否常见。
我们对1988年至1997年间在两家城市医院接受子宫切除术的HIV感染患者和对照患者的子宫病理标本进行了回顾性分析，这些患者在年龄、手术指征和促性腺激素释放激素（GnRH）使用史方面相匹配。对病例评估浆细胞的存在情况，并给予0至3级评分。
手术指征包括宫颈发育异常（4例）、原位癌（2例）、子宫异常出血（3例）和附件包块（3例）。所有病例均出现某种程度的子宫异常出血。与HIV阴性标本相比，HIV感染女性中浆细胞性子宫内膜炎的发生率是其两倍（11/11对11/22）（P < 0.05）。HIV感染女性标本中的浆细胞性子宫内膜炎分级也高于对照组（P = 0.001）。
在我们的系列研究中，需要进行子宫切除术的HIV感染女性中慢性子宫内膜炎很常见且分级更高。对于有子宫出血和/或压痛的HIV感染女性，应考虑子宫内膜炎的诊断和治疗。我们推测，针对子宫内膜炎的抗逆转录病毒和/或抗菌治疗可能有效治疗子宫内膜炎，并消除一些HIV感染女性的手术需求。我们建议，对可能进行子宫切除术的HIV-1感染女性考虑并治疗子宫内膜炎，有可能降低患者和可能在手术过程中暴露的医疗人员的成本和发病率。
