The Women's Interagency HIV Study (WIHS), a multicenter, prospective study, was established in August 1993 to carry out comprehensive investigations of the impact of HIV infection and its clinical, laboratory, and psychosocial effects in women. The purpose of this study is to collect and evaluate these data from HIV infected and at-risk women to better understand and provide support for women whom are currently HIV infected or who are at risk for HIV infection.

HIV in women is increasing worldwide, with women comprising approximately 14% of the total adult and adolescent AIDS cases, the highest proportion yet reported. The impact of AIDS is particularly severe in minority populations; among women, African Americans, and Hispanics combined now represent the majority of AIDS cases (76%) in the United States. AIDS is now the third leading cause of death for women aged 25 to 44 (after cancer and cardiovascular disease) and is the leading cause of death of African American women in this age group.

Studies of HIV and AIDS in women can play a unique role in testing new biological or socio-behavioral hypotheses at the population level and in linking basic science findings and laboratory methods to well-defined populations and communities. Research areas that are likely to draw more attention in the near future will include the study of pathogenicity and transmissibility of different HIV subtypes or recombinant forms and their interaction with variably susceptible individuals; the change in the scope of HIV natural history studies in the era of combination antiretroviral therapy; and the contribution of such studies to the design of a wide spectrum of prevention modalities (e.g., prevention of HIV and prevention of opportunistic infections). In addition, studies of natural history of HIV-related malignancies and active surveillance of malignancies in HIV infected and high-risk uninfected women may lead to new screening and prevention modalities in high-risk populations of women.

Participants will have study visits every 6 months. Questionnaires regarding sexual behavior, health care utilization, medical and obstetric/gynecological history, psychosocial factors, and sociodemographics will be completed by participants. Physical, gynecological, and lipodystrophy examinations will also be conducted at each visit, and current medication regimen will be noted. Blood and other bodily fluid samples will be collected and registered in both local and national repositories of the WIHS in conjunction with NIAID.

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• Minkoff H, Ahdieh L, Watts H, Greenblatt RM, Schmidt J, Schneider M, Stek A. The relationship of pregnancy to the use of highly active antiretroviral therapy. Am J Obstet Gynecol. 2001 May;184(6):1221-7.
• French AL, Kirstein LM, Massad LS, Semba RD, Minkoff H, Landesman S, Palefsky J, Young M, Anastos K, Cohen MH. Association of vitamin A deficiency with cervical squamous intraepithelial lesions in human immunodeficiency virus-infected women. J Infect Dis. 2000 Oct;182(4):1084-9.
• Greenspan D, Komaroff E, Redford M, Phelan JA, Navazesh M, Alves ME, Kamrath H, Mulligan R, Barr CE, Greenspan JS. Oral mucosal lesions and HIV viral load in the Women's Interagency HIV Study (WIHS). J Acquir Immune Defic Syndr. 2000 Sep 1;25(1):44-50.
• Mirmirani P, Hessol NA, Maurer TA, Berger TG, Nguyen P, Khalsa A, Gurtman A, Micci S, Young M, Holman S, Gange SJ, Greenblatt RM. Prevalence and predictors of skin disease in the Women's Interagency HIV Study (WIHS). J Am Acad Dermatol. 2001 May;44(5):785-8.
• Stancliff S, Abel S, Agins B. Oral mucosal lesions and HIV viral load in the Women's Interagency HIV Study (WIHS). J Acquir Immune Defic Syndr. 2001 May 1;27(1):96-7. No abstract available.
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• Strickler HD, Palefsky JM, Shah KV, Anastos K, Klein RS, Minkoff H, Duerr A, Massad LS, Celentano DD, Hall C, Fazzari M, Cu-Uvin S, Bacon M, Schuman P, Levine AM, Durante AJ, Gange S, Melnick S, Burk RD. Human papillomavirus type 16 and immune status in human immunodeficiency virus-seropositive women. J Natl Cancer Inst. 2003 Jul 16;95(14):1062-71.
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• Richardson JL, Martin EM, Jimenez N, Danley K, Cohen M, Carson VL, Sinclair B, Racenstein JM, Reed RA, Levine AM. Neuropsychological functioning in a cohort of HIV infected women: importance of antiretroviral therapy. J Int Neuropsychol Soc. 2002 Sep;8(6):781-93.
• Szczech LA, Gange SJ, van der Horst C, Bartlett JA, Young M, Cohen MH, Anastos K, Klassen PS, Svetkey LP. Predictors of proteinuria and renal failure among women with HIV infection. Kidney Int. 2002 Jan;61(1):195-202.
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• Hessol NA, Anastos K, Levine AM, Ameli N, Cohen M, Young M, Augenbraun M, Miotti P, Gange SJ. Factors associated with incident self-reported AIDS among women enrolled in the women's interagency HIV study (WIHS). WIHS Collaboratorive Study Group. AIDS Res Hum Retroviruses. 2000 Aug 10;16(12):1105-11.
• For the WIHS Collaborative Study Group. Cancer Risk Among Participants in the Women's Interagency HIV Study. J Acquir Immune Defic Syndr. 2004 Aug 1;36(4):978-985.
• Palacio H, Li X, Wilson TE, Sacks H, Cohen MH, Richardson J, Young M, Munoz A; Women's Interagency HIV Study (WIHS). Healthcare use by varied highly active antiretroviral therapy (HAART) strata: HAART use, discontinuation, and naivety. AIDS. 2004 Mar 5;18(4):621-30.
• Szczech LA, Hoover DR, Feldman JG, Cohen MH, Gange SJ, Gooze L, Rubin NR, Young MA, Cai X, Shi Q, Gao W, Anastos K. Association between Renal Disease and Outcomes among HIV-Infected Women Receiving or Not Receiving Antiretroviral Therapy. Clin Infect Dis. 2004 Oct 15;39(8):1199-206. Epub 2004 Sep 27.
• Berhane K, Karim R, Cohen MH, Masri-Lavine L, Young M, Anastos K, Augenbraun M, Watts DH, Levine AM. Impact of Highly Active Antiretroviral Therapy on Anemia and Relationship Between Anemia and Survival in a Large Cohort of HIV-Infected Women: Women's Interagency HIV Study. J Acquir Immune Defic Syndr. 2004 Oct 1;37(2):1245-1252.
• Silverberg MJ, Gore ME, French AL, Gandhi M, Glesby MJ, Kovacs A, Wilson TE, Young MA, Gange SJ. Prevalence of clinical symptoms associated with highly active antiretroviral therapy in the Women's Interagency HIV Study. Clin Infect Dis. 2004 Sep 1;39(5):717-24. Epub 2004 Aug 16.
• Tien PC, Cole SR, Williams CM, Li R, Justman JE, Cohen MH, Young M, Rubin N, Augenbraun M, Grunfeld C. Incidence of lipoatrophy and lipohypertrophy in the women's interagency HIV study. J Acquir Immune Defic Syndr. 2003 Dec 15;34(5):461-6.
• Viscidi RP, Ahdieh-Grant L, Schneider MF, Clayman B, Massad LS, Anastos KM, Burk RD, Minkoff H, Palefsky J, Levine A, Strickler H. Serum immunoglobulin A response to human papillomavirus type 16 virus-like particles in human immunodeficiency virus (HIV)-positive and high-risk HIV-negative women. J Infect Dis. 2003 Dec 15;188(12):1834-44. Epub 2003 Dec 05.
• Wilson TE, Barron Y, Cohen M, Richardson J, Greenblatt R, Sacks HS, Young M; Women's Interagency HIV Study. Adherence to antiretroviral therapy and its association with sexual behavior in a national sample of women with human immunodeficiency virus. Clin Infect Dis. 2002 Feb 15;34(4):529-34. Epub 2002 Jan 09.
• Wilson TE, Gore ME, Greenblatt R, Cohen M, Minkoff H, Silver S, Robison E, Levine A, Gange SJ. Changes in sexual behavior among HIV-infected women after initiation of HAART. Am J Public Health. 2004 Jul;94(7):1141-6.
• Ahdieh-Grant L, Li R, Levine AM, Massad LS, Strickler HD, Minkoff H, Moxley M, Palefsky J, Sacks H, Burk RD, Gange SJ. Highly active antiretroviral therapy and cervical squamous intraepithelial lesions in human immunodeficiency virus-positive women. J Natl Cancer Inst. 2004 Jul 21;96(14):1070-6.
• Anastos K, Barron Y, Cohen MH, Greenblatt RM, Minkoff H, Levine A, Young M, Gange SJ. The prognostic importance of changes in CD4+ cell count and HIV-1 RNA level in women after initiating highly active antiretroviral therapy. Ann Intern Med. 2004 Feb 17;140(4):256-64.
• Augenbraun M, Goedert JJ, Thomas D, Feldman J, Seaberg EC, French AL, Robison E, Nowicki M, Terrault N. Incident hepatitis C virus in women with human immunodeficiency virus infection. Clin Infect Dis. 2003 Nov 15;37(10):1357-64. Epub 2003 Oct 14.
• Barron Y, Cole SR, Greenblatt RM, Cohen MH, Anastos K, DeHovitz JA, Delapenha R, Gange SJ. Effect of discontinuing antiretroviral therapy on survival of women initiated on highly active antiretroviral therapy. AIDS. 2004 Jul 23;18(11):1579-84.
• Cejtin HE, Jacobson L, Springer G, Watts DH, Levine A, Greenblatt R, Anastos K, Minkoff HL, Massad LS, Schmidt JB. Effect of hormonal contraceptive use on plasma HIV-1-RNA levels among HIV-infected women. AIDS. 2003 Jul 25;17(11):1702-4.
• Cole SR, Hernan MA, Robins JM, Anastos K, Chmiel J, Detels R, Ervin C, Feldman J, Greenblatt R, Kingsley L, Lai S, Young M, Cohen M, Munoz A. Effect of highly active antiretroviral therapy on time to acquired immunodeficiency syndrome or death using marginal structural models. Am J Epidemiol. 2003 Oct 1;158(7):687-94.
• Falusi O, French AL, Seaberg EC, Tien PC, Watts DH, Minkoff H, Piessens E, Kovacs A, Anastos K, Cohen MH. Prevalence and predictors of Toxoplasma seropositivity in women with and at risk for human immunodeficiency virus infection. Clin Infect Dis. 2002 Dec 1;35(11):1414-7. Epub 2002 Nov 11.
• Feldman JG, Gange SJ, Bacchetti P, Cohen M, Young M, Squires KE, Williams C, Goldwasser P, Anastos K. Serum albumin is a powerful predictor of survival among HIV-1-infected women. J Acquir Immune Defic Syndr. 2003 May 1;33(1):66-73.
• French AL, Benning L, Anastos K, Augenbraun M, Nowicki M, Sathasivam K, Terrault NA. Longitudinal effect of antiretroviral therapy on markers of hepatic toxicity: impact of hepatitis C coinfection. Clin Infect Dis. 2004 Aug 1;39(3):402-10. Epub 2004 Jul 12.
• Greenspan D, Gange SJ, Phelan JA, Navazesh M, Alves ME, MacPhail LA, Mulligan R, Greenspan JS. Incidence of oral lesions in HIV-1-infected women: reduction with HAART. J Dent Res. 2004 Feb;83(2):145-50.
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• Massad LS, Seaberg EC, Watts DH, Hessol NA, Melnick S, Bitterman P, Anastos K, Silver S, Levine AM, Minkoff H. Low incidence of invasive cervical cancer among HIV-infected US women in a prevention program. AIDS. 2004 Jan 2;18(1):109-13.
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Inclusion Criteria

• HIV-infected or uninfected and at high risk for HIV
• Willing to have blood drawn
• Give consent to have their specimens stored in the WIHS national repository
• Willing to be retested for HIV infection for this study; if hardcopy documentation of a positive result from both an HIV ELISA test and a confirmatory Western blot are available, blood need not be drawn and women need not agree to be retested for HIV
• Able to complete study visit interviews in English or Spanish
• Able to travel to and from site clinic and participate in study visits as an outpatient
• Have consent of parent or guardian if under 18; patients must be at least 18 years of age for enrollment at certain sites
• Have documented highly active antiretroviral therapy (HAART) and pre-HAART CD4 counts and HIV RNA quantification, if appropriate (i.e., HIV-positive, self-reported HAART)

Exclusion Criteria

• Perinatally acquired HIV
• Enrolled in the WIHS through another site
• AIDS-related conditions; if a woman reports an AIDS-related condition during screening that sites can refute through medical records, the woman is still eligible for enrollment