High-Grade Cervical Disease in Adolescents With HIV

Abstract

Infection by genital types of human papillomavirus (HPV), carcinogenic HPV infection, and cervical cancer precursors all are more frequent in HIV-positive women. HPV infections are particularly common in young women. Young women with HIV are more likely than older subjects to have abnormal Pap test results and to develop incident Pap abnormalities. This study was planned to determine the frequency of high-grade squamous intraepithelial lesions (HSIL) and grade 2 or grade 3 cervical intraepithelial neoplasia (CIN 2,3) in 45 HIV-seropositive and 87 HIV-seronegative women aged 20 years or less. Colposcopy was recommended for all grades of epithelial abnormality. None of the 121 adolescents evaluated had either HSIL or CIN 2,3 when enrolled in this study. During a median follow-up interval of 2.6 years, 8 women (7%) developed high-grade disease. The incidence of HSIL/CIN 2,3 was 2.5 per 100 person-years. The figure was 4.8 per 100 person-years in HIV-seropositive women and 1.6 per 100 person-years in those who were HIV-seronegative. The relative risk was 3.1 with a 95% confidence interval of 0.76 to 12.74. None of the women developed cancer during the study. These findings indicate that, in young, HIV-seropositive women, rapid progression of cervical lesions to high-grade disease is unlikely. This would seem to dictate a policy of observation by cytology and colposcopy rather than preventive treatment of low-grade cervical abnormalities.