Ethics The study was approved by the internal review board of CAI

Ethics The study was approved by the internal review board of CAISM/UNICAMP and was conducted in compliance with the current version of the Declaration of Helsinki and with Resolution 196/96 of the Brazilian National Committee for Ethics in Research (CONEP) and its subsequent revisions. This study forms part of a larger study evaluating menopausal symptoms, bone mass, sexual function and metabolic markers. Process: CEP: 407/2010, CAAE 0313.0.146.000-10. Women who agreed to participate in the study after receiving instructions from the researchers and who signed a free informed consent form were included. Results The HIV-positive women were younger and less likely to have a steady partner, to be employed or to have

a formal education compared with the HIV-negative women. More than half the HIV-positive women were premenopausal or perimenopausal. The characteristics of the women interviewed are shown in table 1. Table 1 Some characteristics of women according to HIV status Overall, 41.4% (n=53) of the HIV-positive women and 34.8% (n=62) of the HIV-negative women reported dyspareunia. There was no association between HIV status and dyspareunia (p=0.242). Furthermore, in the multiple regression analysis of the entire sample of HIV-positive and HIV-negative women taken together (n=306), dyspareunia was not associated with HIV status, but was associated with vaginal dryness (prevalence ratio (PR)=2.06, 95% CI 1.37 to 3.10, p=0.001) and urinary

incontinence (PR=1.68, 95% CI 1.14 to 2.46, p=0.008). In the HIV-positive group, 91.4% of the women were currently using ART, and of these 87% reported using ART regularly (data not presented as a table). Approximately 77% of the HIV-positive women had a CD4 cell count nadir >200. The most common way in which HIV had been acquired was by heterosexual transmission, and the average duration of the HIV infection was 9.5±5.6 years (mean±SD), with a mean duration of therapy of 8.7 years±4.5 (mean±SD). A more detailed description of the HIV-infected

women is provided in table 2. Table 2 Characteristics associated to HIV status associated with dyspareunia in women with a sexual partner in the month before the interview (n=128) Bivariate analysis revealed an association between dyspareunia in the HIV-positive women and having a steady Brefeldin_A partner (p=0.047); the woman’s partner having undergone HIV testing (p=0.020); vaginal dryness (p<0.001); muscle/joint pain (p=0.021); physical/emotional violence (p=0.049); urinary incontinence (p=0.004); and the use of lamivudine/zidovudine (p=0.048), table 3. Table 3 Factors associated with dyspareunia (score ≥2) in middle-aged HIV-positive women: bivariate analysis According to the Poisson multiple regression analysis, the principal factors associated with dyspareunia in the group of HIV-positive women were: vaginal dryness (PR=1.96; 95% CI 1.10 to 3.50; p=0.023) and urinary incontinence (PR=1.86; 95% CI 1.06 to 3.27; p=0.031; table 4).

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