Squamous intraepithelial lesions in HIV-infected women: prevalence, incidence, progression and regression
- 233 Downloads
To evaluate the impact of HIV immune depletion, highly active antiretroviral therapy (HAART) and patient characteristics on the occurrence of cervical squamous intraepithelial lesions (SIL).
A total of 898 HIV-positive women were evaluated at the time of their first Pap smear and 388 of them received additional Pap smears during follow-up in a cohort study. The patients were enrolled from July 1997 to April 2007. Prevalence and incidence of SIL in Pap smears were studied. Progression and regression were evaluated in follow-up of patients presenting low-grade SIL.
Pap smear results at baseline were: 741 normal (82.5 %), 56 atypical squamous cells of indeterminate significance (ASCUS) (6.2 %), 78 low-grade SIL (8.7 %), 22 high-grade SIL (2.4 %), and 1 invasive cervical cancer (0.1 %). SIL cumulative incidence rate was 9.7 %. Progression and regression occurred in 15.9 and 62 %, respectively. Multivariate analysis of CD4 counts ≤200 cells/mm3 (aHR = 2.1; 95 % CI 1.3–3.5; P = 0.004) and age less than 30 years (aHR = 3.2; 95 % CI 1.5–6.8; P = 0.01) or less than 40 years old (aHR = 2.6; 95 % CI 1.2–5.7; P = 0.01) were significantly associated with SIL prevalence. CD4 counts ≤200 cells/mm3 (aHR = 3.0; 95 % CI 1.2–7.2; P = 0.01) and higher viral load counts (for each log increase) were associated with SIL incidence (aHR = 1.4; 95 % CI 1–1.9; P = 0.048).
Prevalence and incidence of SIL in HIV-positive women were associated with severity of HIV disease. Interventions to increase access to Pap smears and further diagnostic tests should be implemented and targeted to HIV-positive women.
KeywordsCervical intraepithelial neoplasia Vaginal smears HIV
This study was partially supported by CNPq, Brazilian Ministry of Science and Technology.
Conflict of interest
The authors have nothing to disclose with regard to potential conflicts of interest.
The study was approved by the IRB of the Hospital Presidente Vargas from the Municipal Health Department of Porto Alegre and all women gave their informed consent to participate.
- 1.INCA/MS (2012) Cancer surveillance data in Brazil http://www.inca.gov.br. Accessed 17 Jan 2013
- 5.Delmas MC, Larsen C, van Benthem B, Hamers FF, Bergeron C, Poveda JD et al (2000) Cervical squamous intraepithelial lesions in HIV-infected women: prevalence, incidence and regression. European Study Group on Natural History of HIV Infection in Women. AIDS 14(12):1775–1784PubMedCrossRefGoogle Scholar
- 10.Brazil MoH- (2012) Recommendations for the use of antiretroviral therapy in HIV infected adolescents and adults http://www.aids.gov.br/sites/default/files/anexos/publicacao/2012/52140/consenso_adulto2012_principais_mudancas_pdf_11946.pdf. Accessed 17 Jan 2013
- 14.Silva R, Reis A, Russomano F, Fialho S, Grinsztein B (2003) Cervical intraepithelial lesions among HIV infected patients. DST J bras Doenças Sex Transm 15(3):16–20Google Scholar
- 16.INCA/MS (2003) Brazilian nomeclature for Pap smear test results and management guidelines http://www.aprp.org.br/arquivos/Texto_Nomenclatura_brasileira_citopatologia_28%5B1%5D.07.03-versao_final.doc. Accessed 15 Feb 2013
- 17.INCA/MS (2006) Brazilian nomeclature for Pap smear test results and management guidelines http://www.inca.gov.br/inca/Arquivos/Titulos/Nomenclatura_colo_do_utero.pdf. Accessed 15 Feb 2013
- 21.Nappi L, Carriero C, Bettocchi S, Herrero J, Vimercati A, Putignano G (2005) Cervical squamous intraepithelial lesions of low-grade in HIV-infected women: recurrence, persistence, and progression, in treated and untreated women. Eur J Obstet Gynecol Reprod Biol 121(2):226–232PubMedCrossRefGoogle Scholar
- 31.Robinson WR, Luck MB, Kendall MA, Darragh TM (2003) The predictive value of cytologic testing in women with the human immunodeficiency virus who have low-grade squamous cervical lesions: a substudy of a randomized, phase III chemoprevention trial. Am J Obstet Gynecol 188(4):896–900PubMedCrossRefGoogle Scholar