Prognostic evaluation of DNA index in HIV-HPV co-infected women cervical samples attending in reference centers for HIV-AIDS in Recife.

Albert Eduardo Silva Martins,Aureliana Barbosa,Stefan Welkovic,Maria Luiza Bezerra Menezes,Ricardo A A Ximenes,Renan Gomes Garcia,Terezinha Tenório,Magda Maruza,Norma Lucena-Silva,Jianming Tang

doi:10.1371/journal.pone.0104801

Abstract

IntroductionPersistence of cervical infection caused by human papillomavirus (HPV) types with high oncogenic risk may lead to cervical intraepithelial neoplasia (CIN). The aim of the present study was to evaluate whether, in HIV-positive women, the presence of aneuploidy in cervical cell samples is associated with presence and evolution of CIN.MethodsThe present study had two stages. In the first stage, comprising a cross-sectional study, the association between the presence of aneuploidy seen via flow cytometry and sociodemographic characteristics, habits and characteristics relating to HPV and HIV infection was analyzed. In the second stage, comprising a cohort study, it was investigated whether aneuploidy was predictive of CIN evolution.ResultsNo association was observed between the presence of aneuploidy and HPV infection, or between its presence and alterations seen in oncotic cytological analysis. On the other hand, aneuploidy was associated with the presence of CIN (p = 0.030) in histological analysis and with nonuse of antiretroviral therapy (p = 0.001). Most of the HIV-positive women (234/272) presented normal CD4+ T lymphocyte counts (greater than 350 cells/mm3) and showed a greater aneuploidy regression rate (77.5%) than a progression rate (23.9%) over a follow-up of up to two years.ConclusionAlthough there was an association between the presence of cervical tissue lesions and the DNA index, the latter was not predictive of progression of the cervical lesion. This suggests that progression of the cervical lesion to cancer in HIV-positive women may also be changed through improvement of the immunological state enabled by using antiretroviral therapy.

Highlights

Persistence of cervical infection caused by human papillomavirus (HPV) types with high oncogenic risk may lead to cervical intraepithelial neoplasia (CIN)
Persistence of cervical infection caused by the human papillomavirus (HPV) is a risk factor for the development of cervical cancer and, in patients coinfected with HIV, the cervical lesions are more severe and have a worse prognosis [1,2,3]
Prolongation of the S phase through the action of E6 and E7 may lead to chromosome instability and to alteration of cell ploidy. These events are worsened by the phenomenon of viral integration, which may occur in situations of persistent infection by high-risk HPV, the transformation phase may occur in stages that precede the viral integration [6,7,8,9]

Summary

Introduction

Persistence of cervical infection caused by human papillomavirus (HPV) types with high oncogenic risk may lead to cervical intraepithelial neoplasia (CIN). Prolongation of the S phase through the action of E6 and E7 may lead to chromosome instability and to alteration of cell ploidy. These events are worsened by the phenomenon of viral integration, which may occur in situations of persistent infection by high-risk HPV, the transformation phase may occur in stages that precede the viral integration [6,7,8,9]

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Conclusion