Recent Submissions

  • The Relationship of Cocaine Use and Human Immunodeficiency Virus Serostatus to Incident Sexually Transmitted Diseases Among Women

    WILSON, TRACEY E.; Minkoff, Howard; DeHovitz, Jack; FELDMAN, JOSEPH; LANDESMAN, SHELDON (Ovid Technologies (Wolters Kluwer Health), 1998-02)
    Background and objectives: To assess the incidence of sexually transmitted diseases (STD) in a group of heterosexual women as a function of human immunodeficiency virus (HIV) serostatus and to ascertain the effect of crack cocaine use on these relationships. Study design: At baseline, 445 HIV type 1 (HIV-1) seronegative and 232 seropositive women were provided interviews ascertaining demographic and behavioral risk factors. All participants were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis at baseline and at 6-month intervals. Results: HIV serostatus was not related to STD incidence. Although HIV-positive women reported more condom use than did HIV-negative women (P < .01), only 65% reported using them consistently. Increases in the frequency of crack cocaine use, measured on a 4-point scale, were positively associated with rates of new STDs (relative risk [RR] = 1.23, P < .01). Crack cocaine use was also associated with greater numbers of sexual partners and less consistent condom use. The relationship between HIV status and the probability of acquiring an STD was not influenced by frequency of crack use. Conclusion: Women infected with HIV or who use crack cocaine are at risk for transmitting HIV and acquiring other STDs. Whether women are infected with or at risk for HIV, programs are needed to prevent and treat crack addiction. Interventions should target high-risk sexual practices among both female crack users and women living with HIV.
  • Sexual, contraceptive, and drug use behaviors of women with HIV and those at high risk for infection: results from the Women‚s Interagency HIV Study

    Wilson, Tracey E.; Massad, L. Stewart; Riester, Katherine A.; Barkan, Susan; Richardson, Jean; Young, Mary; Gurtman, Alexandra; Greenblatt, Ruth (Ovid Technologies (Wolters Kluwer Health), 1999-04)
    Objective: To document the sexual and contraceptive practices of women with HIV infection or who are at risk for infection. Design: Data on the baseline behaviors of 561 HIV-negative and 2040 HIV-positive women were collected as part of the Women's Interagency HIV Study (WIHS). WIHS is a multisite, longitudinal study following the natural history of HIV infection among women in the United States. Methods: Each participant contributed an interviewer administered, self-report interview including questions on sexual and contraceptive behavior. Results: Women with HIV were less likely to report heterosexual activity in the previous 6 months (65% HIV-positive, 76% HIV-negative). Among sexually active women, there were no differences in the proportion of those reporting vaginal (97% HIV-positive, 98% HIV-negative) or anal sex (12% HIV-positive, 10% HIV-negative), although women with HIV were less likely to report cunnilingus (41% HIV-positive, 70% HIV-negative) and fellatio (48% HIV-positive, 57% HIV-negative). Of women with HIV, 63% always used condoms during vaginal sex (versus 28% HIV-negative), with lower rates reported during other sexual activities. Crack, cocaine, or injecting drug use, reported by 27% of HIV-positive and 35% of HIV-negative women, was associated with inconsistent condom use, independent of serostatus. HIV-positive women who reported using condoms and another contraception method were less consistent condom users (57% consistent versus 67%). Conclusions: The prevalence of sexual risk behavior in this sample suggests that, although women with HIV exhibit lower levels of sexual risk behavior than uninfected women, many have not been successfully reached with regard to implementing safer behaviors. These findings have implications for more widespread and effective behavioral intervention efforts.
  • Predictors and Risk-Taking Consequences of Drug Use Among HIV-Infected Women

    Novotná, Lenka; Wilson, Tracey E.; Minkoff, Howard L.; McNutt, Louise-Anne; DeHovitz, Jack A.; Ehrlich, Ira; Des Jarlais, Don C. (Ovid Technologies (Wolters Kluwer Health), 1999-04)
    Objective: To determine rates of drug use among women with HIV, and to examine associations between drug use, health, risk behavior, and sexually transmitted diseases (STD). Design: A longitudinal cohort study of 260 women with confirmed HIV-positive serostatus. Methods: Each participant contributed a self-report interview, a clinical examination, laboratory testing of cultures for Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and urinalysis for the presence of metabolites of cocaine and opiates. Data were examined on 140 women at 1-year follow-up. Women were defined as drug users if they reported crack, cocaine, or heroin use in the 6 months before the interview or if they had a positive toxicologic test result for cocaine or opiates. Results: 34% of those in the sample were classified as positive for drug use. Drug use was associated with the number of sexual partners, age at first intercourse, prevalence of STDs, and lower quality of life. STDs were present at baseline in 33.7% and 15.5% of drug users and nonusers, respectively. Drug use among this population was also associated at both baseline and follow-up with the likelihood of having a Karnofsky score below 80, and with overall perceived general health. Conclusions: Drug users in this cohort were more likely to engage in behaviors that place them at risk for STDs, to have elevated STD prevalence, and to have lower perceived health across several indices. Identification of drug use and treatment for it need to be a central component of HIV care for women.
  • Mandatory HIV testing of infants and rates of follow-up care.

    Wilson, T E; Minkoff, H (American Public Health Association, 1999-10)
  • Acceptance of HIV Testing During Prenatal Care

    Isabel Fernandez, M. (SAGE Publications, 2000-10-01)
    Objective: The purpose of this study was to assess the factors associated with acceptance of HIV testing during pregnancy on the part of women receiving prenatal care at public clinics. Methods: Trained interviewers recruited and interviewed 1,357 women receiving prenatal care at clinics in Florida, Connecticut, and New York City. Results: Eighty-six percent of participants reported having been tested or having signed a consent form to be tested. Acceptance of testing was found to be related to strong beliefs about the benefits of testing, knowledge about vertical transmission, perceived provider endorsement of testing, and social support. Women who declined testing said they did so because they did not perceive themselves to be at risk for HIV (21%) or they faced administrative difficulties (16%) with some aspect of the testing process (for example, scheduling, limited availability of pre-test counselors). Conclusions: Acceptance rates can be increased when women understand the modes of vertical transmission and the role of medication regimens in preventing transmission; believe that prenatal identification of HIV can promote the health of mother and child; and perceive their providers as strongly endorsing testing. These points can be woven into a brief pre-test counseling message and made a routine component of prenatal care.
  • Psychiatric Morbidity Among STD Clinic Patients

    WILSON, TRACEY E. (Ovid Technologies (Wolters Kluwer Health), 2001-05)
  • A Case Control Study of Beliefs and Behaviors Associated With Sexually Transmitted Disease Occurrence in Estonia

    WILSON, TRACEY E.; UUSK??LA, ANNELI; FELDMAN, JOSEPH; Holman, Susan; DeHovitz, Jack (Ovid Technologies (Wolters Kluwer Health), 2001-11)
    Background: Epidemiologic data document rapidly increasing sexually transmitted disease (STD) rates throughout Eastern Europe. Goal: This case-control study was designed to delineate factors contributing to the STD epidemic in Estonia. Study design: For this study, 189 study participants and 112 control subjects completed a behavioral questionnaire and underwent testing for Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum. Results: The prevalence of STDs among the control subjects was 32%. Although the participants believed that condoms prevent STDs, only 17% reported consistent use. Methods believed to prevent transmission included washing the genitals (65%), urinating (26%), douching (35%), and using oral contraceptives (19%). An interaction between sex and travel outside Estonia (odds ratio, 0.1; 95% CI, 0-0.7) reflects the fact that males with STDs were more likely to report travel (46% of participants and 45.5% of control subjects with STD) than were those without STD (16.1% of controls without STD). Conclusions: STD rates are related to high-risk sexual behavior among males traveling outside of Estonia. Intervention is needed to promote understanding of disease transmission dynamics in this area, and to decrease sexual risk behavior, particularly in the context of travel.
  • Barriers to universal prenatal HIV testing in 4 US locations in 1997

    Royce, R A; Walter, E B; Fernandez, M I; Wilson, T E; Ickovics, J R; Simonds, R J (American Public Health Association, 2001-05-01)
    Objectives: We determined rates of prenatal HIV testing and investigated barriers to testing. Methods: We surveyed 1362 representative parturient women from 7 hospitals in 4 locations of the United States. Results: Overall, 89.9% of women reported being offered HIV testing and 69.6% reported being tested. Proportions of women not offered testing differed by location (range = 5.2%-16.3%), as did proportions not tested (range = 12.2%-54.4%). Among women who perceived that their clinicians had not recommended testing, 41.7% were tested, compared with 92.8% of women who perceived a strong recommendation (P < .05). Private insurance for prenatal care was also associated with not being tested. Women gave multiple reasons for not being tested, most commonly not being at risk, having been tested recently, and the test's not being offered or recommended, cited by 55.3%, 39.1% and 11.1% of women, respectively. Conclusions: Although most parturient women were offered a prenatal HIV test and got tested, testing proportions did not reach national goals and differed significantly by location and payment status. Concern about testing consequences was not a major barrier. Perception of clinicians' recommendations strongly influenced testing. Changing provider practices will be essential to implementing universal prenatal HIV testing.
  • Prenatal and Postpartum Zidovudine Adherence Among Pregnant Women with HIV

    Ickovics, Jeannette R.; Wilson, Tracey E.; Royce, Rachel A.; Minkoff, Howard L.; Fernandez, M. Isabel; Fox-Tierney, Rachel; Koenig, Linda J. (Ovid Technologies (Wolters Kluwer Health), 2002-07)
    Adherence to HIV treatment regimens during pregnancy may affect efforts to eliminate vertical transmission and influence the emergence of drug-resistant HIV strains that can affect maternal health and the risk of vertically-transmitted resistant strains. Study objectives were to document patterns of adherence to zidovudine (ZDV) during the perinatal period. Pregnant women with HIV who were seen at public clinics, taking ZDV, and willing to use Medication Event Monitoring Systems (MEMS) caps participated in this adherence substudy. Fifty-three women were included in prenatal analyses; however, 19 women were excluded from postnatal analyses because medical records failed to confirm a postpartum maternal prescription for ZDV. Adherence to ZDV, defined as doses per day taken/prescribed during the last 3 weeks of pregnancy, was extremely low (mean = 50.0%), and declined significantly 3 weeks postpartum (mean = 34.1%) (p =.004). Clinical emphasis must be placed on enhancing adherence during and particularly after pregnancy when ZDV is continued for a mother's own care.
  • Adherence to Antiretroviral Therapy and Its Association with Sexual Behavior in a National Sample of Women with Human Immunodeficiency Virus

    Wilson, Tracey E.; Barrón, Yolanda; Cohen, Mardge; Richardson, Jean; Greenblatt, Ruth; Sacks, Henry S.; Young, Mary (Oxford University Press (OUP), 2002-01-09)
    To delineate the relationship between adherence to human immunodeficiency virus (HIV) therapy and sexual behavior among HIV type 1-infected women in the United States, data were collected from October 1998 through March 1999 from 766 HIV-positive women on adherence to therapy, risk behavior, and disease markers. Adherence rates of >/=95% were reported by 66% of the patients. In multivariate analyses, patients with lower rates of adherence tended to be younger (odds ratio [OR], 1.69), to be active drug users (OR, 2.27), to have detectable virus load levels (OR, 2.00), and to have a lower quality of life (OR, 1.20). Among sexually active women, lower adherence rates were associated with an increased risk for inconsistent condom use (adjusted OR, 2.17). Although counseling regarding sexual behavior and adherence to treatment regimens are often addressed separately, our data highlight the importance of discussing these factors in relation to one another, particularly with regard to patients experiencing virologic failure.
  • Use of Highly Active Antiretroviral Therapy in a Cohort of HIV-Seropositive Women

    Cook, Judith A.; Cohen, Mardge H.; Grey, Dennis; Kirstein, Lynn; Burke, Jane; Anastos, Kathryn; Palacio, Herminia; Richardson, Jean; Wilson, Tracey E.; Young, Mary (American Public Health Association, 2002-01)
    Objectives: This study examined longitudinal trends in use of highly active antiretroviral therapy (HAART) among a cohort of HIV-positive participants in the Women' Interagency HIV Study. Methods: Beginning in 1994, 1690 HIV-positive women reported detailed information about their use of antiretroviral therapy at 6-month study visits. Multivariate logistic and Cox regression analyses were used to estimate the likelihood of antiretroviral therapy and HAART use among women with study visits preceding and following HAART availability. Results: Before the availability of HAART, the cohort' likelihood of any antiretroviral therapy use was associated with clinical indicators (CD4 count, viral load, symptom presence) as well as behavioral factors (abstaining from drug and alcohol use, participating in clinical trials). After HAART became commercially available, newly emerging predictors included college education, private insurance, absence of injection drug use history, and not being African American. Conclusions: After the penetration of HAART into this cohort, additional differences emerged between HAART users and nonusers. These findings can inform public health efforts to enhance women' access to the most effective types of therapy.
  • Violence During Pregnancy Among Women With or at Risk for HIV Infection

    Koenig, Linda J.; Whitaker, Daniel J.; Royce, Rachel A.; Wilson, Tracey E.; Callahan, Michelle R.; Fernandez, M. Isabel (American Public Health Association, 2002-03)
    Objectives: This study estimated the prevalence of violence during pregnancy in relation to HIV infection. Methods: Violence, current partnerships, and HIV risk behaviors were assessed among 336 HIV-seropositive and 298 HIV-seronegative at-risk pregnant women. Results: Overall, 8.9% of women experienced recent violence; 21.5% currently had abusive partners. Violence was experienced by women in all partnership categories (range = 3.8% with nonabusive partners to 53.6% with physically abusive partners). Neither experiencing violence nor having an abusive partner differed by serostatus. Receiving an HIV diagnosis prenatally did not increase risk. Disclosure-related violence occurred, but was rare. Conclusions: Many HIV-infected pregnant women experience violence, but it is not typically attributable to their serostatus. Prenatal services should incorporate screening and counseling for all women at risk for violence.
  • The perinatal guidelines evaluation project HIV and pregnancy study: overview and cohort description

    Ethier, Kathleen A; Ickovics, Jeannette R; Fernandez, M.Isabel; Wilson, Tracey E; Royce, Rachel A; Koenig, Linda J (SAGE Publications, 2002-03)
    Objective: The HIV and Pregnancy Study of the Perinatal Guidelines Evaluation Project is a prospective, longitudinal, multisite study established to: (a) assess the implementation of Public Health Service guidelines regarding the prevention of perinatal HIV transmission and (b) evaluate the psychosocial consequences of HIV infection among pregnant women. A distinctive aspect of the study is the use of an HIV-negative comparison group. This article describes the methodology of the study and baseline characteristics of the study sample. Methods and Results. HIV-infected (n = 336) and uninfected (n = 298) pregnant women were enrolled from four geographic areas: Connecticut, North Carolina, Brooklyn, NY, and Miami, FL. The study included three structured face-to-face interviews from late pregnancy to six months postpartum for HIV-infected and uninfected women. Additional self-reports of medication adherence were collected for the HIV-infected participants, and the medical records of infected mothers and their infants were reviewed. Electronic monitoring of medication adherence was conducted for a subset of the infected women. The groups were successfully matched on self-reported characteristics, including HIV-risk behaviors. More than half of the uninfected women reported a high-risk sexual partner. Baseline comparisons indicated that both the HIV-infected and uninfected women had high levels of depressive symptoms, stress, and recent negative life events. Conclusions: This study provides a unique description of the psychosocial and behavioral characteristics of a population of low-income women. The results of this study suggest that HIV infection is one of many stressors faced by the women in this study.
  • Dual Contraceptive Method Use for Pregnancy and Disease Prevention Among HIV-Infected and HIV-Uninfected Women

    WILSON, TRACEY E.; Koenig, Linda J.; WALTER, EMMANUAL; FERNANDEZ, ISABEL; Ethier, Kathleen (Ovid Technologies (Wolters Kluwer Health), 2003-11)
    Background and objectives: Many women who report condom use also use other methods of birth control such as oral contraceptive pills. The use of 2 or more contraceptive methods often results in less consistent condom use. Goal: This study sought to document the prevalence and patterns of such dual contraceptive use among HIV-seropositive and HIV-seronegative women, and to assess factors associated with condom-only versus dual contraceptive use. Study design: At 6 months postpartum, 361 sexually active women were interviewed regarding sexual behavior, male condom and other contraceptive use, and psychosocial factors. Results: Dual contraceptive method use was reported by 39% of sexually active women; 30% reported using condoms only. Almost two thirds of dual method users (64%) reported always using these methods together (ie, simultaneously) during vaginal sex. Among dual users, those who used methods simultaneously were more likely to be HIV-seropositive (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.2-6.5), to believe that a pregnancy would be very upsetting should it occur in the next 6 months (OR, 2.4; 95% CI, 1.1-5.4), and to report no alcohol use (OR, 3.7; 95% CI, 1.5-9.2). Conclusion: Dual contraceptive users should be encouraged to use methods together at every episode of vaginal sex. Interventions promoting simultaneous use should include pregnancy attitudes and the role of alcohol use, as well as a consideration of HIV serostatus as it impacts on dual use.
  • Contraception Use, Family Planning, and Unprotected Sex: Few Differences Among HIV-Infected and Uninfected Postpartum Women in Four US States

    Wilson, Tracey E.; Koenig, Linda; Ickovics, Jeannette; Walter, Emmanuel; Suss, Amy; Fernandez, M. Isabel (Ovid Technologies (Wolters Kluwer Health), 2003-08)
    To describe pregnancy intentions and contraceptive use among a postpartum sample of women with and at risk for HIV infection, 258 HIV-seropositive and 228 HIV-seronegative women were recruited from prenatal clinics in 4 US states between June 1996-November 1998. Participants completed interviews at 24-40 weeks' gestation and at 6 months postpartum. At the 6-month interview, 78% of women reported vaginal sex, and 2% were pregnant. Among those not pregnant, 86% said that there was no likelihood of a pregnancy in the next 6 months. Condom use was reported by 68% of sexually active women; 65% of users reported consistent use. Those with HIV were more likely to report condom use, more likely to report condom use consistency, and less likely to report use of oral contraceptives than women without HIV (P < 0.05). In multivariate analysis, inconsistent condom use was associated with postpartum alcohol use (odds ratio [OR] 2.80; 95% CI = 1.34-5.84), with the respondent stating that a pregnancy would not be emotionally upsetting (OR 3.06; 95% CI = 1.41-6.59) and reporting an intention to terminate a pregnancy if one were to occur (OR 3.47; 95% CI = 1.58-7.60). HIV-seropositive women who had at least 1 child with HIV infection were less likely than seronegative women to report inconsistent condom use (OR 0.15; 95% CI = 0.03-0.76). Few differences were detected in reproductive behaviors as a function of HIV serostatus, although both cohorts engaged in unprotected sex. Counseling to decrease sexual risk behaviors should begin prior to or early in the postpartum period and include discussion of both reproductive and disease
  • Healthcare use by varied highly active antiretroviral therapy (HAART) strata: HAART use, discontinuation, and naivety.

    Palacio, Herminia; Li, Xiuhong; Wilson, Tracey E; Sacks, Henry; Cohen, Mardge H; Richardson, Jean; Young, Mary; Muñoz, Alvaro (2004-03-05)
    Objectives: Prior reports have found a temporal association between the introduction of highly active antiretroviral therapy (HAART) and population rates of health service use among persons living with HIV. Our objective was to explore further the effect of HAART by comparing healthcare use among persons who use HAART and persons who discontinue HAART to that among HAART-naive and HIV-negative persons.
  • Medically Eligible Women Who Do Not Use HAART: The Importance of Abuse, Drug Use, and Race

    Cohen, Mardge H.; Cook, Judith A.; Grey, Dennis; Young, Mary; Hanau, Lawrence H.; Tien, Phyllis; Levine, Alexandra M.; Wilson, Tracey E. (American Public Health Association, 2004-07)
    Objectives: We investigated the prevalence and characteristics of HIV-positive women who do not report highly active antiretroviral therapy (HAART) use. Methods: We analyzed HAART use among 1165 HIV-positive participants in the Women's Interagency HIV Study. Results: Between October 1, 2000, and March 31, 2001, 254 women with clinical indications for HAART reported not using it, 635 reported HAART use, and 276 had no clinical indications. In multivariate analysis, using crack/cocaine/heroin and a history of abuse decreased the likelihood of using HAART, whereas being White increased it. Conclusions: One of 4 women for whom HAART was indicated reported not using HAART. Childhood sexual abuse prevention, more intensive abuse treatment, and continuing drug treatment may enhance HIV disease treatment of women.
  • Depressive Symptoms and AIDS-Related Mortality Among a Multisite Cohort of HIV-Positive Women

    Cook, Judith A.; Grey, Dennis; Burke, Jane; Cohen, Mardge H.; Gurtman, Alejandra C.; Richardson, Jean L.; Wilson, Tracey E.; Young, Mary A.; Hessol, Nancy A. (American Public Health Association, 2004-07)
    Objectives: We examined associations between depressive symptoms and AIDS-related mortality after controlling for antiretroviral therapy use, mental health treatment, medication adherence, substance abuse, clinical indicators, and demographic factors. Methods: One thousand seven hundred sixteen HIV-seropositive women completed semiannual visits from 1994 through 2001 to clinics at 6 sites. Multivariate Cox and logistic regression analyses estimated time to AIDS-related death and depressive symptom severity. Results: After we controlled for all other factors, AIDS-related deaths were more likely among women with chronic depressive symptoms, and symptoms were more severe among women in the terminal phase of their illness. Mental health service use was associated with reduced mortality. Conclusions: Treatment for depression is a critically important component of comprehensive care for HIV-seropositive women, especially those with end-stage disease.
  • Changes in Sexual Behavior Among HIV-Infected Women After Initiation of HAART

    Wilson, Tracey E.; Gore, Mary Elizabeth; Greenblatt, Ruth; Cohen, Mardge; Minkoff, Howard; Silver, Sylvia; Robison, Esther; Levine, Alexandra; Gange, Stephen J. (American Public Health Association, 2004-07)
    Objectives: We assessed the association between initiation of highly active antiretroviral treatment (HAART) regimens and sexual risk behaviors among HIVinfected women. Methods: We analyzed data from 724 women who initiated HAART between January 1996 and January 2001 and who had pre-HAART viral loads at or above 400 copies per milliliter. Results: Sexually active women were less likely (odds ratio [OR] = 0.79) to report 2 or more partners during a 6-month period after HAART initiation than before HAART initiation. However, the risk for unprotected sex was higher after HAART initiation than before HAART initiation among all sexually active women (both those who reported 2 or more partners [OR = 1.84] and those who reported 1 partner [OR = 1.22]). Conclusions: Sexual risk behaviors are associated with receipt of therapy but not with therapeutic response, indicating a risk for transmission among female HAART recipients.
  • Prevalence of Clinical Symptoms Associated with Highly Active Antiretroviral Therapy in the Women's Interagency HIV Study

    Silverberg, M. J.; Gore, M. E.; French, A. L.; Gandhi, M.; Glesby, M. J.; Kovacs, A.; Wilson, T. E.; Young, M. A.; Gange, S. J. (Oxford University Press (OUP), 2004-09-01)
    Background: The extended use of antiretroviral drugs among human immunodeficiency virus (HIV)-seropositive individuals underscores the need for a comprehensive evaluation of therapy-associated clinical symptoms. Methods: Beginning in April 2000, 364 HIV-seronegative and 1256 HIV-seropositive women enrolled in a multicenter cohort study reported clinical symptoms that included abdominal pain, diarrhea, anorexia, nausea and/or vomiting, myalgias, fatigue, fever, body fat redistribution, dizziness, headaches, paresthesias, xerostomia, nephrolithiasis, and rash. We examined the prevalence of symptoms with respect to HIV infection and the use of highly active antiretroviral therapy (HAART), using data-correlation models. Results: In the 6 months before a study visit, 49% of HIV-seronegative women, 67% of HIV-seropositive women not receiving therapy, and 69% of HIV-seropositive women receiving HAART reported any clinical symptom. The odds ratios (ORs) for reporting any symptom were 1.4 (95% confidence interval [CI], 1.1-1.8) for women who changed HAART regimens and 0.9 (95% CI, 0.7-1.1) for women reporting stable HAART use, compared with those reporting no therapy use. Significant findings (P<.05) for particular symptoms were an increased odds of diarrhea, nausea and/or vomiting, body fat redistribution, myalgias, and paresthesias, when data for women who changed HAART regimens were compared with those for women not receiving therapy. The OR for reporting any symptom was 1.5 (95% CI, 1.2-1.9) for women who switched HAART regimens and 1.6 (95% CI, 1.3-1.9) for women who discontinued HAART, compared with those reporting stable HAART use. Conclusions: Our findings confirm the high prevalence of clinical symptoms among HIV-seropositive women who changed HAART regimens. The high prevalence of symptoms among HIV-seronegative women and HIV-seropositive women not receiving therapy demonstrates that caution should be used when attributing the occurrence of symptoms entirely to HAART.

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