Correlation of Cervical Squamous Intraepithelial Lesions with Human Papillomavirus in Women Infected with the Human Immunodeficiency Virus

Abstract

The human papillomavirus (HPV) is the major etiologic agent in the development of cervical cancer with known risk factors like immunosuppression. The natural history of HPV infection is altered in persons infected with the human immunodeficiency virus (HIV). The persistent HPV infection increases their risk of having cervical squamous intraepithelial lesions (SILs). This study emphasizes on prevalence of high-risk human papillomavirus (HR-HPV) and correlation with cervical smears cytology in HIV-positive women regardless of treatment. A cross-sectional observational study was conducted at a tertiary care hospital over a period of 2 years. The study group is comprised of HIV seropositive women attending antiretroviral treatment center. CD4 cell counts were taken from the records available, and cervical samples were taken for cytological analysis and HR-HPV testing. Statistical analysis was done using the software Epi 6 Info, and p value was calculated by Chi-square test and Fisher’s exact 2-tailed test for associations of abnormal cytology and to determine risk factors for abnormal cytology. The median age of the 100 participants was 33.34 years. Low-grade squamous intraepithelial neoplasms (LSILs), high-grade squamous intraepithelial neoplasms, atypical squamous cells of uncertain significance and atypical glandular cells were the precancerous lesions found. Prevalence of HR-HPV in HIV-positive women was found to be 35% among women with abnormal smears. A strong correlation between SILs and HR-HPV with p value of < 0.05 was found. A strong statistical correlation was also seen in between low CD4 count to that of detection of HR-HPV along with LSIL. A strong correlation between cervical SILs and HR-HPV in our study suggests that routine screening of cervical cytology by PAP smear should include HPV subtype identification in HIV-positive women to pick up cases which are likely to progress to invasive carcinoma.