Hysterosalpingographic evaluation of human immunodeficiency virus-infected and uninfected infertile women

BACKGROUND: Hysterosalpingography (HSG) is an outpatient fluoroscopy-guided procedure that evaluates the uterine cavity and fallopian tube patency in infertile women. Its cost-effective use is being challenged with the human immunodeficiency virus (HIV) burden in KwaZulu-Natal, which characteristically affects multiple organs. OBJECTIVES: The aim of this study was to describe the HSG findings in a group of HIV-infected and uninfected infertile women. METHOD: This was a retrospective study conducted over a 4-year period (2012–2016) in which the HSG images and reports of 178 infertile patients from records of the Radiology Department were re-reviewed for abnormalities of the cervix, uterus and fallopian tubes. Their clinical data and radiological findings were entered into a pre-coded data sheet and analysed. RESULTS: The frequency of HIV infection amongst patients with infertility was found to be 32.6%. Forty-four patients were on antiretroviral therapy at the time of the HSG examination, whereas three had not yet started treatment. From the 178 HSG reports, 109 (61.2%) were abnormal. Tubal pathologies were the most common abnormalities, accounting for 79 of the 109 cases and was higher in HIV-infected women than in HIV-uninfected women (p = 0.001). Uterine filling defects were demonstrated in 13 of the 109 cases. There were two cases of cervical abnormalities. CONCLUSION: The study demonstrated that tubal abnormalities were the most common findings amongst infertile women undergoing HSG and occurred predominantly in HIV-infected patients.