Case series of infertility amongst young women with perinatally acquired HIV: data from a London cohort

Introduction: Increased rates of infertility have been reported in women who acquired HIV horizontally compared to population age-matched normative data. However, few data exist for adults with perinatally acquired HIV (PaHIV), who have been exposed to antiretroviral drugs and/or HIV-associated ill health through childhood and puberty. We describe a case series of infertility amongst women with PaHIV attending a London clinic between 2006 and 2017. Methods: A retrospective case-note review was conducted amongst all female PaHIV patients aged >16 years attending a London clinic. All data was captured into an electronic database using paper and electronic clinical records taken from every routine clinic visit (average three times/year between 2006 and 2017). Data captured included HIV viral load, CD4 cell count, antiretroviral therapy regimen, sexual and reproductive health and STI screening. Age-matched analysis of infertility rates compared to the general population were not performed. Results: In total, 119 young women were included, with a median age of 20 years (interquartile range [IQR] 18-24, range 16-33 years) at latest follow-up. Three women with PaHIV were diagnosed with infertility (n=3): two with primary ovarian insufficiency (n=2) and one with hypogonadotropic hypogonadism (n=1). A further 5/116 (4.3%) were under investigation for menstrual irregularities. Of the remaining 111 young women, 17 (15%) had successfully conceived. All patients were currently prescribed ART, with 93 (78%) having an HIV VL <50 copies/mL at their last visit. Median ART exposure was 13 (IQR 9-17) years. Among five women with reported irregular menstrual cycles there was no correlation with current CD4 cell count, HIV VL or length of ART exposure, although there was an increased prevalence of body mass index >25 kg/m(2) (63% vs 30%). Conclusion: Overall the reproductive health status for young women with PaHIV was comparable to the general population.