Human Immunodeficiency Virus Seropositive Women Research Articles

Prevalence of Chlamydia trachomatis in human immunodeficiency virus-infected women in Cuba.

To determine the prevalence rates and serovar distribution of Chlamydia trachomatis cervical infections in Cuban women, two different groups were selected. Group I consisted of 60 human immunodeficiency virus (HIV-1) seropositive women from different regions of Cuba and group II of 60 randomly selected women HIV seronegative and apparently healthy. C. trachomatis was detected in cervical scrapes by mean of nested polymerase chain reaction (PCR) specific for major out membrane protein. The overall prevalence rate of C. trachomatis in cervical scrapes determined by nested PCR was 10% in group I and the estimated prevalence was 6.6% for group II; 83.3% of HIV seropositive women with C. trachomatis infection reported history of pelvic inflammatory disease followed by cervicitis (50%). The control group C. trachomatis-infected women referred a history of cervicitis in 75% of cases. Other reports in the latter group included infertility and pelvic inflamatory disease in 50%. The present study is the first report of C. trachomatis prevalence in Cuba. It showed that there was not significantly difference in the prevalence rate of C. trachomatis between both groups.

Endocrine function in HIV-infected women

Infection with the human immunodeficiency virus (HIV) results in a chronic systemic illness with multi-organ involvement, severe immunosuppression and profound cachexia. It has had a major impact on women'shealth. Endocrine abnormalities may contribute to the clinical presentation and therefore appropriate treatment would theoretically improve the patient's condition. This pilot study was undertaken to assessthe endocrine status in a group of HIV seropositive women with the view to developing recommendations for future investigations.Thirteen women were recruited from a clinic for HIV-infected patients.All women had a comprehensive general and gynecological examination. Basal endocrine status was assessed and combined pituitary testing with gonadotropin-releasing hormone, thyrotropin-releasing hormone,growth hormone-releasing hormone and corticotropin-releasing hormone was performed.None of the participating women presented with gynecological complaints or had symptoms suggestive of an endocrinopathy.On questioning, seven women complained of menstrual abnormalities. Three had a body mass index of less than 20 kg/m2. Genital tract infections were common. Endocrine assessment demonstrated abnormalitiesof the pituitary-adrenal, pituitary-thyroid and pituitary-ovarian axes in seven women. One woman had panhypopituitarism. In six of the seven affected women CD4 counts were below 200 cells/mm3.Alterations in endocrine function were observed in seven of the women tested. While routine endocrine testing may not be indicated in all HIV-seropositive women, we should be aware of possible subtlepresentations of endocrine abnormalities which may require treatment, especially in stress situations.

Detección del virus herpes humano tipo 8 en sarcoma de Kaposi, mieloma múltiple y síndromes linfoproliferativos en pacientes con inmunodepresión y sin ella

The purposes of this study were: to study the presence of human herpesvirus-8 (HHV-8) in different Kaposi's sarcoma (KS) epidemiological groups, multiple myeloma (MM), and immunodeficiency-associated lymphoid proliferations; to investigate the potential sexual transmission of HHV-8 by analyzing its presence in women from the general population, human immunodeficiency virus (HIV) seropositive women, and prostitutes; and to establish a reliable and efficient PCR strategy for the detection of HHV-8. HHV-8 detection was performed by PCR and positive cases were confirmed by automatic bi-directional sequencing. We selected 25 KS, 70 immunodeficiency associated non-Hodgkin's lymphomas (NHL), 30 HIV-positive Hodgkin's lymphomas (HL), and 2 primary effusion lymphomas (PEL). Bone marrow aspirates were available from 41 MM, 9 monoclonal gammopathies of undetermined significance and 24 patients with other disorders. Bone marrow dendritic cell cultures from 12 MM patients were also performed. Cells from cervical, anal, and oral cavity scrapes were examined for the presence of HHV-8 in 40 control women, 10 HIV-seropositive women, and 20 HIV-seronegative prostitutes. Serologic tests were also performed. HHV-8 was specifically detected in 100% KS and PEL, and in 5.7% immunodeficiency associated NHL. All cases of HIV-HL and MM were HHV-8 negative. Antibodies against HHV-8 were found in 10% of control women, 10% HIV-positive women, and 25% prostitutes. Only 1 sample was positive for HHV-8 by PCR. HHV-8 is associated with all epidemiological forms of KS; HHV-8 does not contribute to the pathogenesis of MM, and this virus is not ubiquitous in the human population. Seroprevalence of HHV-8 is increased in prostitutes, although this may partially be attributed to the geographical origin. For a reliable PCR detection of HHV-8, it is necessary to target different regions of the viral genome and to sequence amplification products.

Human immunodeficiency virus infection in women without wasting is associated with menstrual cycle decreases in free testosterone levels.

Human immunodeficiency virus infection in women without wasting is associated with menstrual cycle decreases in free testosterone levels.

Postoperative morbidity associated with cesarean delivery among human immunodeficiency virus–seropositive women

Objective: The aim of this study was to compare the complication rates associated with cesarean delivery between human immunodeficiency virus–seropositive women with those among a matched group of human immunodeficiency virus–seronegative subjects. Study Design: We conducted a case-control study of 86 human immunodeficiency virus–seropositive women undergoing cesarean delivery between the years 1992 and 2000 at a large, urban teaching institution and a control group of 86 human immunodeficiency virus–seronegative women matched for age, race, year of delivery, and delivery indications. Data were analyzed with the χ2 test and odds ratios. Among human immunodeficiency virus–seropositive women, complications were further stratified according to maternal disease status and use of antiretroviral therapy. Results: Human immunodeficiency virus–seropositive women were significantly more likely than control women to have minor postoperative complications (66.3% vs 41.8%; odds ratio, 2.73; 95% confidence interval, 1.40-6.10), of which febrile morbidity was the most common (62.8% vs 42.7%; P =.003). There was no difference between the groups in the rate of major complications (9.3% vs 3.4%; odds ratio, 2.84; 95% confidence interval, 0.65-14.06). Zidovudine use was associated with a decrease in the maternal morbidity rate (odds ratio, 0.31; 95% confidence interval, 0.07-1.03). Conclusion: Postoperative morbidity among human immunodeficiency virus–seropositive women undergoing cesarean delivery was not different from that in a matched control population. (Am J Obstet Gynecol 2001;184:1108-11.)

Increased Risk of Cervical Disease Among Human Immunodeficiency Virus–Infected Women With Severe Immunosuppression and High Human Papillomavirus Load

In Brief Objective To investigate human papillomavirus (HPV) genotypes, HPV DNA load, and behavioral and sociodemographic factors in a series of human immunodeficiency virus (HIV)-seropositive women, and to correlate HPV infection with cervical disease according to immune status. Methods Three hundred seven HIV-seropositive women were tested for the presence of HPV DNA by polymerase chain reaction (PCR) and Southern blot hybridization. Cervical disease was assessed using Papanicolaou smears, colposcopy, and biopsies when necessary. Various risk factors for cervical intraepithelial neoplasia (CIN) were tested using multiple logistic regression analysis. Results Cervical disease was diagnosed in 83 (27.0%) of 307 women and HPV infection in 162 (52.8%). High HPV load (as detectable by Southern blot hybridization) was found in 90 (55.6%) of the 162 infected women. Potentially oncogenic or related genotypes were detected in 74 (82.2%) of these 90 cases. High-load HPV infection was twice as frequent in severely immunosuppressed women (CD4 cell count less than 200/μL) as in women with higher CD4 cell counts (P = .002). High-load HPV infection was associated with a high risk of cervical disease (adjusted odds ratio [OR] 16.8; 95% confidence interval [CI] 7.0, 40.3). The risk among severely immunosuppressed women was ten times greater than that among women with CD4 cell counts of at least 200/μL. Low-load HPV infection (detected by PCR only) was a risk factor for CIN in severely immunosuppressed women only (adjusted OR 7.4; 95% CI 1.3, 43.0). Conclusion Immunosuppression favors cervical high-load HPV infection with oncogenic genotypes and its clinical expression in HIV-seropositive women. Immunosuppression favors cervical high-load human papillomavirus infection with oncogenic genotypes and its clinical expression in human immunodeficiency virus–seropositive women.

Absence of maternal-fetal transmission of human immunodeficiency virus type 1 to second-trimester fetuses

Objective: The aim of this study was to evaluate the contribution of in utero infection to the vertical transmission of human immunodeficiency virus type 1 during the second trimester. Study Design: We examined fetal tissues from 21 second-trimester prostaglandin-induced abortions among human immunodeficiency virus type 1–infected women and compared the fetal vertical transmission rates with those among children born to human immunodeficiency virus–seropositive women. The presence of human immunodeficiency virus type 1 nucleic acid sequences was investigated with two different highly sensitive polymerase chain reaction techniques in tissue samples from the fetal thymus, lung, and brain. Results: No human immunodeficiency virus type 1 deoxyribonucleic acid was detected in any of the samples. Conclusion: The absence of human immunodeficiency virus type 1 in all fetuses in our study is compatible with a low rate of maternal-fetal transmission during the second trimester of pregnancy. (Am J Obstet Gynecol 2000;183:638-42.)

Demographic and clinical profile of human immunodeficiency virus-infected postpartum women who undergo sterilization

The decision of human immunodeficiency virus (HIV)-infected women to accept a contraceptive method has implications related to the prevention of HIV infection to their children. A case-control study was performed in 57 HIV seropositive pregnant women with prenatal care and delivery at the National Institute of Perinatology, Mexico City. Thirty-five cases were women who accepted postpartum sterilization and twenty-two controls were women who refused this method. The acceptance of tubal occlusion was statistically more frequent in multiparous women, and in those with previous children infected with HIV. The antecedent of at least one previous pregnancy had an association with the acceptance of tubal occlusion with an OR of 11.2 (CI 95% 2.9 to 42.9); having at least one previous child HIV-infected had an OR of 4.6 (CI 95% 1.3 to 23.1). The stratified analysis did not show modification of the association strength between previous pregnancy and the precedent of previous children HIV-infected with the acceptance of sterilization.

Vaginal infections in human immunodeficiency virus–infected women

Objective: This study was undertaken to compare the frequencies of vaginal infections among human immunodeficiency virus–infected women with those among human immunodeficiency virus–seronegative women. Study Design: Human immunodeficiency virus–seropositive women attending a comprehensive care center for human immunodeficiency virus disease at the outpatient department of an inner-city hospital in Houston underwent rigorous gynecologic evaluation for sexually transmitted diseases, including evidence of vaginal infections such as bacterial vaginosis, vulvovaginal candidiasis, and trichomonal vaginitis. Demographic information was collected, as was information regarding disease classification and degree of immunosuppression. Data regarding sexually transmitted diseases, data regarding vaginal infections, and demographic information were collected from a cohort of human immunodeficiency virus–seronegative women attending a sexually transmitted disease and family planning clinic at the same institution. The two groups were compared to determine whether there were any differences between them in the frequencies of sexually transmitted diseases and vaginal infection. Data analysis used the t test for parametric data and the Fisher exact test for nonparametric data where appropriate. P <.05 was considered significant. Statistical analysis was performed with the SAS (SAS Institute, Inc, Cary, NC) statistical software package. Results: There was no difference in age between the 2 groups. The human immunodeficiency virus–infected group was predominantly African American (80.5%), whereas the human immunodeficiency virus–seronegative control group was more evenly divided between African American women (45.8%) and Latinos (41.7%; P <.0001). Although there was no significant association between HIV infection and sexually transmitted diseases in general, there were significant associations between human immunodeficiency virus infection and bacterial vaginosis (P =.02), vulvovaginal candidiasis (P =.001), and trichomonal vaginitis (P =.003). Conclusion: Human immunodeficiency virus–infected women had increased frequencies of vaginal infections, including bacterial vaginosis, vulvovaginal candidiasis, and trichomonal vaginitis, with respect to human immunodeficiency virus–seronegative control subjects. No differences between the 2 groups were seen in the frequencies of sexually transmitted diseases. (Am J Obstet Gynecol 2000;183:347-55.)

Specific serum IgG, IgM and IgA antibodies to human papillomavirus types 6, 11, 16, 18 and 31 virus-like particles in human immunodeficiency virus-seropositive women.

To evaluate the humoral immune response to human papillomavirus (HPV) in women infected with human immunodeficiency virus (HIV), serum samples of 83 HIV-positive individuals were analysed by ELISA for specific antibodies of the isotypes IgG, IgA and IgM recognizing HPV-6, -11, -16, -18 and -31 L1 virus-like particles (VLPs). Papillomavirus-related lesions were present in 30 of 83 HIV-positive women. Twenty-one women (25%) presented with high-/intermediate-grade anogenital squamous intraepithelial lesions. PCR analysis and sequencing for HPV typing was done from biopsy specimens of 18 women; PCR-positive results were obtained in 90% of cases. In addition, HPV DNA hybrid capture assays were performed from cervical swabs of 58 HIV-positive women, 53% of whom had a positive result for high-risk HPV. Overall, positive IgG reactivity to HPV-6/-11 and HPV-16/-18/-31 was seen in 19%/31% and 49%/30%/24% of HIV-positive women, respectively. HPV-seropositivity was even higher than in 48 HIV-negative cervical intraepithelial neoplasia/cancer patients with percentages as follows: 8%/2% and 31%/15%/15%. This difference was significant for HPV-16 (P=0.046). IgA responses were comparable to IgG. IgM responses were low. The extraordinarily high rate of antibodies to the capsid protein L1 of high-risk HPVs (HPV-16, -18 and/or -31) in 58% of HIV-positive women compared to 19% (P=0.00001) of 102 healthy HIV-negative control women suggests a high lifetime cumulative exposure to HPV and increased expression of capsid proteins due to cellular immunodeficiency in HIV-infected women.

Positive cone biopsy specimen margins in women infected with the human immunodeficiency virus

Objectives: The purpose of this study was to compare the positive margin rate associated with cervical conization among women who are seropositive for human immunodeficiency virus with that among women who are seronegative. Study Design: This was a cross-sectional study of 245 women who underwent cervical conization for the following indications: biopsy-proven cervical intraepithelial neoplasia grade 2 or 3, abnormal endocervical curettage specimen, cytologic-histologic examination discrepancy, persistent cervical intraepithelial neoplasia grade 1, or abnormal cytologic characteristics with inadequate colposcopic examination. Results: Twenty-two (47.8%) of 46 women who were seropositive for human immunodeficiency virus and 65 (32.7%) of 199 women who were seronegative had positive cone biopsy specimen margins. In a multivariable logistic regression the human immunodeficiency virus–seropositive women had a 2-fold increased risk of having a positive cone biopsy margin (odds ratio, 2.25; 95% confidence interval, 1.07-4.76). Conclusion: If the presence of positive cone biopsy specimen margins represents the potential for disease progression, then our findings of a positive margin rate of nearly 50% in a human immunodeficiency virus–positive population may argue against the kind of conservative management of colposcopic follow-up that has been proposed for immunocompetent women. (Am J Obstet Gynecol 1999;181:1395-9.)

Human immunodeficiency virus antibody in patients with cancer of the uterine cervix undergoing radiotherapy: clinical stages, histological grade and outcome of radiotherapy

One hundred and twenty consecutive patients with cancer of the uterine cervix were screened for human immunodeficiency virus (HIV) seropositivity before and after radiotherapy. The severity of the disease in terms of clinical staging and histological grading of HIV seropositive women was compared with that of seronegative women. The result showed a prevalence rate of 4.2% for HIV seropositivity which was similar to the rate quoted for the general populace in Nigeria. The HIV seropositive women presented with more severe disease state than the HIV seronegative women. The mean duration of remission was significantly shorter in the HIV seropositive women following radiotherapy (18.36+/3.96 vs. 24.24+/-6.3 months). It was concluded that HIV infection increases the severity and progression of cancer of the cervix in Nigerians. Radiotherapy has no effect on the patients' seropositivity and possibly no effect on the virus. A more aggressive treatment of carcinoma of the cervix and closer follow-up of HIV seropositive patients following treatment are necessary.

A Longitudinal Study of Human Papillomavirus Carriage in Human Immunodeficiency Virus-Infected and Human Immunodeficiency Virus-Uninfected Women

Abstract OBJECTIVE: We sought to determine the relationship of human immunodeficiency virus serostatus to carriage of oncogenic human papillomavirus. MATERIAL AND METHODS: A total of 268 human immunodeficiency virus–infected and 265 human immunodeficiency virus–uninfected women were seen every 6 months, at which time they had laboratory tests performed including a CD4 count. Human papillomavirus deoxyribonucleic acid was analyzed by polymerase chain reaction. Statistical methods included Kaplan-Meier and Cox's proportional hazard models. RESULTS: The prevalence at baseline of any human papillomavirus type was 73% and 43% among human immunodeficiency virus–seropositive and seronegative women, respectively ( p p 3 ( p p p CONCLUSIONS: Human immunodeficiency virus–seropositive women are more likely to have newly detectable oncogenic types of human papillomavirus at follow-up and to show persistent carriage of oncogenic types of human papillomavirus types. Among human immunodeficiency virus–infected women, those with higher CD4 counts were more likely to have a newly detected oncogenic human papillomavirus during follow-up. (Am J Obstet Gynecol 1998;178:982-6.)

Oral Lesions among Women Living with or at Risk for HIV Infection

Purpose: Our objectives were to compare the prevalence of oropharyngeal mucosal lesions among human immunodeficiency virus (HIV) seropositive and demographically similar seronegative women, and to determine the association of oral lesions with immunosuppression, substance abuse, use of medications, and utilization of dental services. Population and Methods: Participants in a multicenter, longitudinal cohort study of HIV infection in women were evaluated at baseline by interview, physical examination, and laboratory studies. Results: Oropharyngeal pathology was found in 40% of seropositive and 23% of seronegative women. Oral candidiasis was identified in 15% of seropositive and 3% of seronegative women. Among seropositive women, history of previous oral candidiasis, lower CD4 lymphocyte counts, and current antibiotic use were associated with oral candidiasis. Hairy leukoplakia was identified in 5% of seropositive women and was significantly associated with lower CD4 lymphocyte counts. Gingival erythema and ulcerative gingivitis were found in 23% of participants overall, but were unrelated to HIV serostatus or CD4 lymphocyte count. Substance abuse, lack of dental care, and African-American race were associated with gingival pathology. Conclusion: The high prevalence of oral lesions among HIV seropositive and at-risk seronegative women underscores the need for routine oral examination and targeted treatment of this population.

A longitudinal study of human papillomavirus carriage in human immunodeficiency virus–infected and human immunodeficiency virus–uninfected women

OBJECTIVE: We sought to determine the relationship of human immunodeficiency virus serostatus to carriage of oncogenic human papillomavirus. MATERIAL AND METHODS: A total of 268 human immunodeficiency virus–infected and 265 human immunodeficiency virus–uninfected women were seen every 6 months, at which time they had laboratory tests performed including a CD4 count. Human papillomavirus deoxyribonucleic acid was analyzed by polymerase chain reaction. Statistical methods included Kaplan-Meier and Cox's proportional hazard models. RESULTS: The prevalence at baseline of any human papillomavirus type was 73% and 43% among human immunodeficiency virus–seropositive and seronegative women, respectively ( p < 0.0001) and of oncogenic types was 32.5% and 17.0% ( p < 0.001). The prevalence of oncogenic human papillomavirus was higher in women with CD4 counts <200 mm 3 ( p < 0.001). The rate of detection of new oncogenic human papillomavirus per 100 patient years of follow-up in human immunodeficiency virus–seropositive women was almost three times higher than among human immunodeficiency virus–seronegative women ( p < 0.01). The rate of loss of an oncogenic human papillomavirus was higher in the human immunodeficiency virus–seronegative women but the difference was not significant. The relative risk of a human immunodeficiency virus–infected woman who did not initially have a specific type of oncogenic human papillomavirus having one detected during follow-up was 6.6 times greater than among human immunodeficiency virus–negative women ( p < 0.001). CONCLUSIONS: Human immunodeficiency virus–seropositive women are more likely to have newly detectable oncogenic types of human papillomavirus at follow-up and to show persistent carriage of oncogenic types of human papillomavirus types. Among human immunodeficiency virus–infected women, those with higher CD4 counts were more likely to have a newly detected oncogenic human papillomavirus during follow-up. (Am J Obstet Gynecol 1998;178:982-6.)

Adequacy of Screening Cervical Cytology among Human Immunodeficiency Virus-Seropositive Women

Objective.To evaluate the adequacy of cytology in detecting cervical intraepithelial neoplasia (CIN) among human immunodeficiency virus (HIV)-seropositive women compared to controls.Methods.A cross-sectional study was carried out evaluating 241 HIV-seropositive women and 991 controls (404 HIV seronegative and 587 of unknown HIV status) at risk for CIN attending a vaginitis clinic. All patients had a Pap smear and a standard colposcopic examination of the lower genital tract. Cervical biopsies were taken as indicated by colposcopy. Cytology and histology slides were read by a cytopathologist blinded to patients' serostatus. False-negative cytologic cases were reviewed by three independent cytopathologists to estimate sampling and screening error rates. Sensitivity, specificity, and false-negative rate of cytologic smears were compared between HIV seropositives and controls. We estimated the sampling and screening error rates among cases with false-negative cytology.Results.Among seropositives, the sensitivity, specificity, and the false-negative smear rate for CIN were 73.4% (47/64), 97.1% (134/138), and 26.6% (17/64), respectively. The corresponding figures in controls were 83.8% (83/99), 99.04% (825/833), and 16.2% (16/99), respectively, and did not differ significantly from those of seropositives. The negative predictive value of cytology was lower among seropositives (134/151) than in controls (825/841, χ2= 34.8,P< .001). The agreement between cytologic readings and combined colposcopy and histology was stronger among controls (kappa = 0.789, 95% CI 0.723 to 0.856) than among seropositives (kappa = 0.593, 95% CI 0.475 to 0.712). Three independent cytopathologists were unable to detect atypical cells in 52.9% (9/17) of false-negative smears taken from seropositive women as opposed to 37.5% (6/16) of controls.Conclusions.The sensitivity, specificity, and false negative rate of screening cytology for CIN among HIV seropositive women are comparable with those in the general population. Since almost 50% of false-negative results could be attributed to sampling errors, more frequent cytological screening may prove to be beneficial to this high-risk group.

Cervicovaginal human immunodeficiency virus secretion and plasma viral load in human immunodeficiency virus-seropositive women

To evaluate human immunodeficiency virus (HIV)-1 RNA burden in paired plasma and cervicovaginal lavage specimens and to assess the relation of plasma HIV-1 RNA level, CD4 cell count, and antiretroviral therapy with cervicovaginal HIV-1 viral load. Paired blood and cervicovaginal lavage specimens were collected from 72 HIV-infected women. Quantitation of HIV-1 RNA from plasma and cervicovaginal lavage specimens was performed by using the nucleic acid sequence-based amplification assay. Analyses examined relations between cervicovaginal HIV-1 RNA and plasma HIV-1 RNA level, CD4 count, and antiretroviral therapy. Plasma HIV-1 RNA was detectable in 61 of 72 women (85%), with copy numbers ranging from 330 to 1,600,000 copies/mL. Twenty-eight of 72 (39%) had detectable HIV-1 RNA in cervicovaginal lavage specimens, ranging from 320 to 440,000 copies/mL. The cervicovaginal lavage HIV-1 RNA level was detectable in 9%, 29%, 52%, and 53% of the women with plasma HIV-1 RNA of less than 400, 400-9999, 10,000-100,000, and more than 100,000 copies, respectively (P = .043). Among women with CD4 counts of less than 200, 200-500, and greater than 500/mm3, cervicovaginal lavage HIV-1 RNA was detected in 67%, 32%, and 25% of subjects, respectively (P = .018). Among women receiving antiretroviral therapy, cervicovaginal lavage revealed HIV-1 RNA in 67%, 31%, and 25% with CD4 cell counts of less than 200, 200-500, and more than 500/mm3, respectively (P = .042). The presence of HIV-1 RNA in cervicovaginal lavage correlates significantly with the level of HIV-1 RNA in plasma and negatively with CD4 cell count.

Papanicolaou smears in human immunodeficiency virus-seropositive women during follow-up

To assess the outcome of cervical squamous intraepithelial lesions (SIL) in human immunodeficiency virus (HIV)-seropositive women. Papanicolaou smears were followed-up prospectively in a group of 60 HIV-positive women every 6 months for 18 months. The cumulative incidence of SIL at 18 months was 9% in 27 women who presented with normal Papanicolaou smears at entry. In 33 women who initially presented with SIL, the rate of persistence of cervical lesions was 95% (18 of 19) in untreated patients and 61% (eight of 13) in women who underwent surgery. In women with low-grade SIL, the persistence or progression of cervical lesions was observed in 92% of the cases (12 of 13). No invasive cancer was observed during the 18 months of the study period. Although the long-term outcome of SIL in this population remains unknown, our results emphasize the high rate of persistence of SIL and the relative inefficiency of conventional treatment in HIV-infected women. These findings contrast with the natural history of SIL in immunocompetent women.

Risks for HIV Infection in Incarcerated Women

ABSTRACT The goal of this research was to investigate risks for exposure to human immunodeficiency virus (HIV) and a spectrum of gynecological comorbidity associated with HIV infection in a population of incarcerated women. Eighty-eight women were selected by HIV infection status and interviewed about HIV risk-taking behaviors, sexual history, and gynecological history. Absolute CD4+ T cell counts and Papanicolaou test results were abstracted from the women's medical charts. Women who reported a history of childhood sexual abuse were more likely to engage in activities that increase susceptibility to HIV infection and were 2.8 times more likely (90% CI = 1.2-6.3) to be infected with HIV, when compared to women who were not sexually abused as children. HIV seropositive women were more likely than HIV seronegative women to report a history of gynecological infection. Specifically, pelvic inflammatory disease, herpesvirus, vaginal candidiasis, and gonorrhea were increased among HIV seropositive women compare...

Cervical Intraepithelial Neoplasia in Jordan: A Ten Year Retrospective Cytoepidemiologic Study

Occurrence of cervical intraepithelial neoplasia (CIN) was studied in 10,659 females attending obstetric and gynecology clinics in Jordan. The frequency rate of intraepithelial neoplasia was 1.1% in 7743 Jordanian females and 2916 non-Jordanian residents of younger age during the period from 1982 to 1991 inclusive. The incidence rate in 2649 Jordanian females, selected because they attended only for routine checkup, was 49 per 100,000. There were 121 CIN cases which were graded into Grade I (21%), II (48%) and III (31%) respectively. Histological grading correlated with cytology in 70% of the cases while in the remaining 30%, cytologic underrating by one grade was noted; evidence against any overdiagnosis of CIN in our series. Study of the human papillomavirus (HPV) was outside the scope of this effort. However, circumcision in male partners and marital status were associated with a lower frequency of CIN. Age at marriage and average duration, parity, breast feeding, the contraceptive pill, socioeconomic status and menstrual disorders showed no relationship to the frequency of CIN in our patients. Any differences in the latter between Jordanian and non-Jordanian females are believed due to cultural factors. Conization in 27 cases proved effective at 30 months' follow-up. Occurrence of CIN in Jordanian females appears substantial although much lower than that seen in high incidence zones, while its incidence in the general female population remains to be determined. This study shows for the first time the value of Papanicolaou (Pap) smears in Jordanian females over 20 years of age with special emphasis on those over 35 years of age attending obstetric and gynecology clinics.