Prevalence, diagnosis and treatment of lower genital neoplasia in women with human immunodeficiency virus infection

Abstract

The prevalence of lower genital neoplasia and Human Papilloma-virus-related genital lesions were evaluated in a cohort of 75 women with Human Immunodeficiency Virus type 1 (HIV-1) infection at different stages of HIV disease. The overall rate of cervical intraepithelial neoplasia (CIN) in the group studied was 29.3% ( 22 75 ). Eight out of 10 high-grade CIN lesions contained ‘high-risk’ HPV-DNA 16 18 and/or 31/35/51 as demonstrated by ‘in situ’ hybridization with biotinylated probes. Vulvar and/or perianal condylomata were histologically diagnosed in 14 patients (18.7%); nine of these biopsies contained detectable HPV-DNA which was always related to HPV 6 11 . The rate of high-grade CIN in symptomatic HIV-infected patients was 28% ( 7 25 ) as compared to 6% ( 3 50 ) of the other cases ( P = 0.022). CD4 lymphocyte counts, white blood cell counts, CD4 + CD8 + cell ratio and percentage of CD4 + lymphocytes were lower in patients with high-grade CIN in comparison to the patients with negative colposcopical and/or cytological examination. After adequate standard treatment (cryotherapy, electrocauterization, cold-knife conization) only one case of CIN 2 recurred during the 2 years of follow-up period. The prevalence of lower genital neoplasia and HPV-related lesions among HIV-infected women is high and seems to correlate with the severity of HIV disease.