Abstract
IntroductionDespite the availability of preventive strategies (screening tests and vaccines), cervical cancer continues to impose a significant health burden in low- and medium-resourced countries. HIV-infected women are at increased risk for infection with human papillomavirus (HPV) and thus development of cervical squamous intraepithelial neoplasia (CIN).MethodsStudy participants included HIV-infected women enrolling the prospective open cohort of Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation (IPEC/FIOCRUZ). At cohort entry, women were subjected to conventional Papanicolaou test, HPV-DNA test and colposcopy; lesions suspicious for CIN were biopsied. Histopathology report was based on directed biopsy or on specimens obtained by excision of the transformation zone or cervical conization. Poisson regression modeling was used to assess factors associated with CIN2+ diagnosis.ResultsThe median age of the 366 HIV-infected women included in the study was 34 years (interquartile range: 28–41 years). The prevalence of CIN1, CIN2 and CIN3 were 20.0%, 3.5%, and 2.2%, respectively. One woman was found to have cervical cancer. The prevalence of CIN2+ was 6.0%. Factors associated with CIN2+ diagnosis in the multivariate model were age < years compared to ≥35 years (aPR = 3.22 95%CI 1.23–8.39), current tobacco use (aPR = 3.69 95%CI 1.54–8.78), nadir CD4 T-cell count <350 cells/mm3 when compared to ≥ 350 cells/mm3 (aPR = 6.03 95%CI 1.50–24.3) and concomitant diagnosis of vulvar and/or vaginal intraepithelial lesion (aPR = 2.68 95%CI 0.99–7.24).DiscussionIncreased survival through wide-spread use of highly active antiretroviral therapy might allow for the development of cervical cancer. In Brazil, limited cytology screening and gynecological care adds further complexity to the HIV-HPV co-infection problem. Integrated HIV care and cervical cancer prevention programs are needed for the prevention of cervical cancer mortality in this group of women.
Highlights
Despite the availability of preventive strategies, cervical cancer continues to impose a significant health burden in low- and medium-resourced countries
Factors associated with CIN2+ diagnosis in the bivariate analysis were age, marital status/living with a partner, number of lifetime sexual partners, tobacco use, number of pregnancies, nadir CD4+ T-cell count, AIDS defining illness, highly-active antiretroviral treatment (HAART) use, and intraepithelial neoplasia of the lower genital tract (VIN and/or Vaginal intraepithelial neoplasia (VaIN)) (p-value,0.20 for all, Table 3)
Our study is the largest report from Latin America on cervical squamous intraepithelial neoplasia (CIN) prevalence in HIV-infected women confirmed by a composite colposcopy-histopathology assessment
Summary
Despite the availability of preventive strategies (screening tests and vaccines), cervical cancer continues to impose a significant health burden in low- and medium-resourced countries. HIV-infected women are at increased risk for infection with human papillomavirus (HPV) and development of cervical squamous intraepithelial neoplasia (CIN). The HIV/AIDS pandemic continues to spread in many parts of the world. The impact of HIV/AIDS pandemic is most pronounced among the poorest and the youngest, with women being overrepresented in these groups [1]. Several studies have consistently identified that HIV-infected women, especially those with low CD4 T-cell counts, are at increased risk for infection with human papillomavirus (HPV) [2,3,4], the etiologic agent of cervical cancer and its precursor lesions. HIV infection has been shown to increase a woman’s risk of developing cervical squamous intraepithelial neoplasia (CIN) and invasive cervical cancer [5,6]
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