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Abstract
Objective: To evaluate the risk of histological high-grade cervical lesions defined as cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in women with human immunodeficiency virus (HIV) infection who had low-grade squamous intraepithelial lesions (LSIL) on cervical cytological screening compared with HIV-uninfected women who had similar cytology. Methods: 127 HIV-positive women aged 18–65 years with LSIL cytology undergoing colposcopic examination between January 2008 and December 2019 at Chiang Mai University Hospital were reviewed. By matching 1:1 ratio for age (±5 years) and examination time period (±12 months), 127 HIV-negative women with LSIL cytology in the same period were recruited as controlled subjects for comparison. The patients’ characteristics, HIV status, CD4 counts, antiretroviral therapy, and histopathology on cervical biopsy were analyzed. Results: HIV-infected women significantly had early sexual debut (age < 20 years) and more sexual partners (≥2) than HIV-uninfected women. The risk of underlying CIN2+ in HIV-infected women was significantly higher than that in HIV-negative women (20.5% vs. 9.4%, p = 0.021) with an odds ratio (OR) of 2.47 and 95% confidence interval (CI) = 1.18–5.14. After adjustment, the risk of underlying CIN2+ in HIV-infected women remained significantly higher than that in HIV-uninfected women (adjusted OR = 2.55, 95% CI = 1.11–5.82, p = 0.027). Conclusion: Among women with LSIL on cervical cytology, the risk of underlying CIN2+ in HIV-infected women was approximately 2.5 times higher than those without HIV infection. Colposcopy is indicated particularly in the case of women with a long duration of HIV infection.
Highlights
Among cancers in women worldwide, cervical cancer ranks fourth for both incidence and mortality following breast, colorectal and lung cancers [1]
According to the American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines, colposcopy is recommended for all human immunodeficiency virus (HIV)-infected women who have low-grade squamous intraepithelial lesions (LSIL) cytology [8]
This study was conducted to evaluate the risk of histological high-grade cervical lesions (CIN2+) in women with HIV infection who had LSIL on cervical cytological screening compared with HIV-uninfected women who had similar cytology
Summary
Among cancers in women worldwide, cervical cancer ranks fourth for both incidence and mortality following breast, colorectal and lung cancers [1]. The incidence of cervical cancer is still high in developing countries whereas it has decreased significantly in the developed countries over the last several decades. 80% of cervical cancers occur in developing countries. In Thailand, cervical cancer ranks second after breast cancer with the estimated age-standardized incidence rate of 16.2 per 100,000 women-year. About 8600 new cases are diagnosed and 5000 women die of cervical cancer [1]. Cervical cancer is currently recognized as the most preventable cancer because almost all cases are caused by human papillomavirus (HPV), the well-known carcinogen [2]
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