Prevalence, Risk Factors, and Clinical Presentation of Uterine Leiomyomas by HIV Status

PROJECT SUMMARY The overarching objective of this project is to determine prevalence, risk factors, and clinical progression of uterine leiomyomas, or uterine fibroids as they are commonly known, and examine differences by HIV serostatus among women in Durban, KwaZulu-Natal, South Africa. Globally, women are doubly impacted by uterine fibroids and HIV infection, with Black women of African descent disproportionately affected by both conditions. Because HIV has been shown to alter the systemic and local genital immunity and tumor necrosis factor, known to be elevated in all stages of HIV, is one of the key drivers of inflammation and is also elevated in cases of symptomatic uterine fibroids, it is prudent to understand uterine fibroid etiological and progression differences by HIV status. South Africa, a country with the highest national burden of HIV globally and very limited data on uterine fibroids serves as a unique setting to achieve the following aims: 1) Describe the 12-month point prevalence of uterine fibroids, overall and by HIV serostatus, among women seeking services at King Edward VIII Hospital; 2) Examine sociodemographic, reproductive health, and sexual health risk factors of uterine fibroids, overall and by HIV serostatus; and 3) Assess potential differences in the frequency, size, uterine fibroid volume, and severity of symptoms of uterine fibroids at baseline and 12-month follow-up, overall and by HIV status, among women with diagnosed uterine fibroids. To address Aim 1, we will compute the 12-month point prevalence of uterine fibroids by tracking the number of women diagnosed over a 12-month period who seek patient care from the King Edward VIII Hospital in Durban, South Africa. To address Aims 2-3, we will conduct a case-control study with follow-up that utilizes survey data to identify risk factors of uterine fibroids (n=480 comprised of 240 with a history of at least one diagnosed uterine fibroid and 240 with no history of uterine fibroids) and objective data via ultrasound to understand differences in uterine fibroid progression by HIV status over a 12-month period, collecting data at baseline and 12-months follow-up (n=240 women with a history of at least one diagnosed uterine fibroid). We will utilize logistic regression models to test associations, stratified by HIV status (Aim 2) and statistical test statistics to examine differences in clinical presentation by the two time points (baseline and 12-month follow- up). Examination of study findings by HIV serostatus can illuminate how the presence of uterine fibroids and associated symptoms may worsen the pre-existing altered immunity state for women with HIV, in turn, exacerbating reproductive and other physical health outcomes. Our findings can lead to integration of screening for uterine fibroids in HIV clinics and integrated care models to address symptomatology of uterine fibroids and HIV care, ultimate improving health outcomes for women with HIV in Durban, South Africa.