Incidence Of Squamous Intraepithelial Lesions Research Articles

Cytology-histology correlation of atypical glandular cells on cervical Papanicolaou tests: A study of 628 cases

IntroductionThe finding of atypical glandular cells on Pap test is becoming more important as the incidence of squamous intraepithelial lesions decreases in recent decades. Therefore, the interpretation and follow-up of patients with AGC are particularly important. The aim of our study was to assess the histologic findings and clinical correlations in patients with atypical glandular cells identified on Pap test. Materials and methodsA total of 714 patients with atypical glandular cells identified on cervical Pap tests were studied for their clinicopathologic features, such as follow-up histology and pateints’ age. We investigated the histologic follow-up results for each individual subcategories of atypical glandular cells and their correlation with patients’ age. ResultsMost of the glandular cell abnormalities (80.0%) in the study group were classified as “atypical glandular cells, NOS”. About 28.9% of patients’ follow-up histology showed malignant or precancerous lesions. The mean age of patients with malignant or precancerous lesions was significantly higher than that of patients with benign or non-precancerous lesions. The malignant histologies included 52 cases of endometrial cancers and 31 cases of cervical carcinomas. The second most common subcategory was “atypical glandular cells, favor neoplastic” (5.0%), while “atypical endocervical cells, favor neoplastic” comprised about 2.7% of cases in our study. The average age of patients with “atypical glandular cells, favor neoplastic” was significantly higher than that of patients with “atypical endocervical cells, favor neoplastic”. The follow-up histology of about 82.1% of “atypical glandular cells, favor neoplastic” showed endometrial (73.9%) or cervical malignancies (26.1%). The follow-up histology of about 70.6% of “atypical endocervical cells, favor neoplastic” showed endometrial (50.0%) or cervical cancers (50.0%). Other glandular abnormalities included 25/714 cases of “atypical endometrial cells” (3.5%) and 6/714 cases of “atypical endocervical cells” (0.8%). ConclusionBased on our data, we have observed significantly more endometrial malignancies in both “atypical glandular cells, NOS” and “atypical glandular cells, favor neoplastic” subcategories and even some in “atypical endocervical cells, favor neoplastic” category. This predominance of endometrial malignancies is also associated with patients’ age and tumor types.

Prevalence of cervical abnormalities amongst HIV-positive women

To study the prevalence and variety of cervical squamous intra-epithelial lesions (SIL) by Pap smear screening as an indicator of suspected HPV infection among HIV-infected women in Surat, Gujarat, India.All consecutive asymptomatic HIV seropositive women 18 years and older and attending the Anti-Retroviral Therapy Centre at New Civil Hospital, Surat, India between October 2009 to September 2011 were eligible for inclusion in the study. Participants constituted 439 asymptomatic HIV seropositive women receiving care at the ART centre underwent detailed history taking, physical examination and Pap smear screening. The incidence of SIL was 8.7% (38/439) in the participants. Further, statistical significance (p value > 0.05) was observed in parity more than two, lost their husband, duration of marriage more than 10 years and CD4 count greater than 250.An association between HIV infection with pre-invasive changes in the cervical epithelium is noted. Early detection and prompt treatment of these changes after a thorough understanding of the natural history of disease in these women would go a long way in improving the survival as well as the quality of life in this increasing seropositive younger population.

CERVICAL CANCER SCREENING IN RURAL WOMEN POPULATION OF LUCKNOW WEST, INDIA: PROBLEMS AND BENEFITS

Carcinoma cervix is a major health problem faced by Indian women and situation is very alarming in rural population because of illiteracy and poverty. There is urgent need of creating awareness regarding the risk factors of cervical cancer such as early marriage and multiparity in the rural women and the importance of early detection of the cervical cancer. With aim for providing single life time Pap smear cover to the rural women, cervical cancer screening program was initiated in May 2013 by Era's Lucknow, Medical College and Hospital, Lucknow, through organizing camps in the villages of Lucknow ,west. Till December 2019, a total of 183 camps have been organized and 5209 women attended these camps (28.5%). Pap smear examination could be done in only 2912 women (55.9%). The incidence of squamous intraepithelial lesions of cervix (SIL) was found to be very high in these women (17.1%) though majority of SIL were of low grade (LSIL). This may be related to the poor personal genital hygiene prevailing in rural women due to illiteracy. In the present review, the SIL incidence has been extensively analyzed in relation to different predisposing factors of cervical carcinogenesis and problems faced during camp organization and the benefits derived from these camps to rural women have been highlighted.

Prevalent, persistent anal HPV infection and squamous intraepithelial lesions: Findings from a cohort of men living with HIV in South Africa.

ObjectiveTo estimate the prevalence, incidence and persistence of anal HPV infection and squamous intra-epithelial lesions (SILs) among men living with HIV (MLHIV), and determine their risk factors.MethodsWe enrolled MLHIV ≥18 years, who attended 6-monthly visits for 18 months. Socio-behavioural data were collected by questionnaire. Clinicians collected blood sample (CD4+ count and HIV plasma viral load), anal swabs (HPV DNA testing) and anal smears (Bethesda classification) at each visit. HPV DNA testing and classification of smears were done at enrolment and last follow-up visit (two time points). Factors associated with persistent anal HPV infection and SILs were evaluated with generalized estimating equations logistic regression and standard logistic regression respectively.ResultsMean age of 304 participants was 38 (Standard Deviation, 8) years; 25% reported >1 sexual partner in the past 3 months. Only 5% reported ever having sex with other men. Most (65%) participants were taking antiretroviral treatment (ART), with a median CD4+ count of 445 cells/μL (IQR, 328–567). Prevalence of any-HPV infection at enrolment was 39% (88/227). In total, 226 men had anal HPV DNA results at both enrolment and final visits. Persistence of any-anal HPV infection among 80 men who had infection at enrolment was 26% (21/80). Any persistent anal HPV infection was more frequent among MLHIV with low CD4+ count (<200 vs. >500 cells/μL; aOR = 6.58; 95%CI: 2.41–17.94). Prevalence of anal SILs at enrolment was 49% (118/242) while incidence of SILs among MLHIV who had no anal dysplasia at enrolment was 27% (34/124). Of the 118 men who had anal dysplasia at enrolment, 15% had regressed and 38% persisted by month 18. Persistent anal HPV infection was associated with persistent SILs (aOR = 2.95; 95%CI: 1.08–10.89). ART status or duration at enrolment were not associated with persistent anal HPV infection or persistent SILs during follow-up.ConclusionIn spite of a high prevalence of anal HPV, HIV-positive heterosexual men have a low burden of anal HPV related disease. HPV vaccine and effective ART with immunological reconstitution could reduce this burden of infection.

Natural History of Anal Squamous Intraepithelial Lesions in HIV-Positive Men with Normal Baseline Cytology.

The natural history of squamous intraepithelial lesions (SILs) in the anal canal of HIV-infected men is incompletely understood. We assessed the incidence and factors associated with SIL and invasive anal squamous cell carcinoma (IASCC) among HIV-infected men with normal cytology at baseline. We performed a single-center prospective cohort study [men who have sex with men (MSM) and men who have sex with women (MSW)]. The incidence of anal canal SIL (low grade and high grade) and IASCC were estimated and predictive factors analyzed. The study population comprised 297 HIV-infected men with a normal cytology result and no anal human papillomavirus (HPV)-related diseases. Of these, 251 (85%) had at least one evaluable set of cytology data during follow-up (172 MSM, 79 MSW). The median follow-up time was 4 years. The cumulative incidence of SIL was 43% (107/251): 52% in MSM (90/172) and 22% in MSW (17/79), p < 0.0001. The incidence rate of SILs was 109 (95% confidence interval = 90-132) per 1000 person-years: 142 in MSM and 49 in MSW, p < 0.0001. HPV infection, receiving antiretroviral treatment (ART), and being MSM were independently associated risk factors. The incidence of IASCC was 0.15 per 1000 person-years among MSM and 0 in MSW. HIV-infected men, both MSM and MSW, are at high risk of developing SIL despite having a normal anal cytology at baseline. The incidence of anal canal SIL was higher among MSM, but was also remarkable among MSW. Independent risk factors associated with SIL were being HIV-infected MSM at high risk for acquisition of STIs, time on ART, and HPV infection.

Results of Cervical Cancer Screening in the Rural Population of Lucknow West, India, through a Camp Approach

Objective: Cytological screening was carried out in rural women of Lucknow West, India, through a camp approach to detect cervical cancer in its preinvasive phase and to see whether the primitive living conditions in the villages have any effect on the incidence of precancer and carcinoma of the cervix and the associated predisposing factors of cervical carcinogenesis. Study Design: During a span of 4 years (May 2013 to March 2017), a total of 135 camps were organized under the auspice of Era’s Lucknow Medical College and Hospital (Lucknow, India). Only 4,269 (31.2%) out of 13,500 women who were motivated and counseled attended the camp and 2,369 (55.1%) of them underwent a Pap smear examination. Results: The incidence of squamous intraepithelial lesions of the cervix (SIL) was found to be very high (18.2%) in the 2,369 women who were screened, but the majority of them were of a low grade. The SIL incidence was very high for all predisposing factors like gynaecological symptoms, age, and clinical lesions of the cervix. However, the SIL rate showed a rise with increasing parity. Candida albicans was more common in rural women (4.7%) than Trichomonas vaginalis (1.1%), and a low incidence of viral sexually transmitted diseases (STD) was seen. Conclusions: Organizing camps in the villages through proper counseling and motivation may help in the screening of larger numbers of women for early detection of cervical cancer, the adequate treatment of which will check the progression of the disease and thus minimize the incidence of carcinoma of the cervix and its associated mortality in the rural population of India.

Cervical Cytology Associated with Pelvic Inflammatory Diseases

Objective: The present study was aimed to investigate the incidence of squamous intraepithelial lesions of cervix (SIL), frank cervical cancer and different STDs in 503 women with pelvic inflammatory disease (PID). Study design: Cytological evolution of cervical smears was carried out in 503 women attending Gynae Outpatient Department of Era’s Lucknow Medical College, Lucknow India, between October 2009 and June 2014 who were diagnosed with PID and also during Rural Cervical Cancer Screening in Malihabad and Kakori Block of Lucknow District between May 2013 to April 2015. Results: The cervical cytology in 503 women with PID showed alarmingly high rate of SIL (144- cases -28.6%) though 134 of them were of low grade. No case of carcinoma cervix was seen. The incidence of Candida albicans was 4.3% in these women and only 2 cases of Trichomonal infection were seen. The incidence of SIL was maximum in younger, sexually active women between 21-30 years after which it declined. Conclusion: The study revealed a very high incidence of SIL associated with PID. As majority of the women screened were from rural areas, it appears that poor hygiene and persistent infection has led to the high incidence of SIL. Hence urgent need is felt in organizing cytological screening programme in rural region of the country to screen specially the symptomatic women to detect any early onset of cervical precancer, the subsequent treatment of which would check any progression of the disease to malignancy.

English

Human papilloma-virus (HPV) infection confers 85-90% of the attributable risk for the development of cervical dysplasia. Worldwide and in particular in Nigeria, HPV 16 has been shown as the most prevalent HPV type and it also contributes more to the development of invasive squamous cell carcinoma. Studies have also shown that the prevalence of HPV is higher among HIV-positive women than among HIV-negative women of all age groups. HIV-positive women also have a higher incidence of squamous intra-epithelial lesion (SIL) and invasive cervical cancer. Progression to cervical cancer is also more rapid amongst these patients and often refractory to treatment with high incidence rates. Current screening recommendations for HIV-positive women are accessible and developed in rich countries. The best strategy for screening infected women in poorer nations where human immunodeficiency virus (HIV) is rampant remains uncertain and challenging. &nbsp; Key words: Human papilloma-virus (HPV), human immunodeficiency virus (HIV), cervical dysplasia, invasive squamous cell carcinoma.

Squamous intraepithelial lesions in HIV-infected women: prevalence, incidence, progression and regression

To evaluate the impact of HIV immune depletion, highly active antiretroviral therapy (HAART) and patient characteristics on the occurrence of cervical squamous intraepithelial lesions (SIL). A total of 898 HIV-positive women were evaluated at the time of their first Pap smear and 388 of them received additional Pap smears during follow-up in a cohort study. The patients were enrolled from July 1997 to April 2007. Prevalence and incidence of SIL in Pap smears were studied. Progression and regression were evaluated in follow-up of patients presenting low-grade SIL. Pap smear results at baseline were: 741 normal (82.5 %), 56 atypical squamous cells of indeterminate significance (ASCUS) (6.2 %), 78 low-grade SIL (8.7 %), 22 high-grade SIL (2.4 %), and 1 invasive cervical cancer (0.1 %). SIL cumulative incidence rate was 9.7 %. Progression and regression occurred in 15.9 and 62 %, respectively. Multivariate analysis of CD4 counts ≤ 200 cells/mm(3) (aHR = 2.1; 95 % CI 1.3-3.5; P = 0.004) and age less than 30 years (aHR = 3.2; 95 % CI 1.5-6.8; P = 0.01) or less than 40 years old (aHR = 2.6; 95 % CI 1.2-5.7; P = 0.01) were significantly associated with SIL prevalence. CD4 counts ≤ 200 cells/mm(3) (aHR = 3.0; 95 % CI 1.2-7.2; P = 0.01) and higher viral load counts (for each log increase) were associated with SIL incidence (aHR = 1.4; 95 % CI 1-1.9; P = 0.048). Prevalence and incidence of SIL in HIV-positive women were associated with severity of HIV disease. Interventions to increase access to Pap smears and further diagnostic tests should be implemented and targeted to HIV-positive women.

Incidence of genital warts in adolescents and their association with cervical intraepithelial lesions

ObjectivesTo estimate the incidence of genital warts in adolescents and analyze their relationship with the development of cervical squamous intraepithelial lesions (SIL). Study designFrom 1993 to 2006 we followed 846 adolescents in the gynecology clinic of a public hospital in Rio de Janeiro. They were sexually active, had a normal smear test and no genital warts upon recruitment and completed two years of follow-up. Data were analyzed using EPI-INFO software. The research was approved by the hospital Ethics Committee. ResultsThe mean age at recruitment was 15.8±1.4 years and at first intercourse was 14.7±1.6. Sixty-three (7.4%) adolescents presented condylomata, 5.6% (48/846) during the first year of sexual activity and 1.8% (15/846) during the second year. Within two years, 20.5% (174/846) of the patients had an abnormal smear test. Seventy percent (44/63) of the patients with genital warts developed a SIL. The association between warts and SIL showed a RR=4.2(3.3–5.3). ConclusionsThe incidence of condylomatawas one third of the incidence of SIL and was higher during the first than in the second year of sexual activity. Adolescents with genital warts had a fourfold increase in risk of SIL and therefore should be carefully followed up.

Highly active antiretroviral therapy and cervical dysplasia in HIV-positive women in South Africa.

BackgroundThe risk of squamous intra-epithelial lesions (SIL) is higher in HIV-positive women. As these women begin to live longer due to highly active antiretroviral therapy (HAART), their risk of cervical cancer may increase. Few data exist regarding the effect of HAART on the incidence and progression of SIL in HIV-positive African women. The aim of this study was to evaluate the effect of HAART on the incidence and progression of SIL in HIV-positive women in South Africa.MethodsA prospective observational study of HIV-seropositive women was conducted over 5 years in an HIV treatment clinic in Johannesburg, South Africa. The participants consisted of 601 women on and off HAART who had repeat Pap smears greater than 6 months apart. The effect of HAART use on incidence and progression rates of SIL was determined using multivariate Poisson regression to obtain incidence rate ratios (IRRs), adjusted for age, CD4 count and other potential confounders.ResultsMedian follow-up time was 445 days (inter-quartile range 383, 671). The crude rate of incidence of any SIL was 15.9 episodes (95% confidence limit (CL) 12.7, 19.9) per 100 person-years; the crude rate of all progression of cervical dysplasia among women was 13.5 episodes (95% CL 11.3, 16.1) per 100 person-years. HAART use was associated with a robust reduction in the rate of incidence and progression of cervical lesions, adjusted IRR=0.55 (95% CL 0.37, 0.80). Sensitivity analyses confirmed this main association held for incidence and progression when they were considered separately, and that the result was not dependent on the length of HAART exposure.ConclusionHAART use was associated with a reduction in the rate of both incidence and progression of cervical lesions among HIV-positive women.

Cytological screening for cervical cancer in the province of Limburg, Belgium

Cervical cancer screening in Belgium is mainly opportunistic with periodic attempts to organize it according to the European guidelines. In the province of Limburg (north-east Belgium), a cervical cytology registry was set up in collaboration with local cytopathological laboratories, provincial health authorities and the Limburg Cancer Registry. Laboratories regularly communicated coded results of Pap smears from women residents in Limburg to the provincial cytological registry. All individual records contained a virtually unique identifying code allowing the study of longitudinal histories and linkage with the cancer registry. The screening coverage (percentage of women with a Pap smear in a defined period), the prevalence and incidence of squamous intraepithelial lesions and changes over time and geographical area were evaluated using a database of more than 600 000 Pap smear interpretations between 1996 and 2005. In 2000, 47% of women aged between 25 and 64 years had at least one Pap smear recorded in the last 3 years, and the average number of smears screened for each woman was 1.5. On account of incomplete registration, the coverage was 8% lower than estimated from health insurance data. The modal screening interval was in the range of 12-14 months; the first quartile, median and third quartile were 355, 440 and 676 days, respectively. Over the 10 years, 82% of the target population had their Pap smear recorded. The prevalence of cytological abnormalities was 3.7% (atypical squamous cells of undetermined significance: 2.2%, atypical glandular cells of undetermined significance: 0.1%, low-grade squamous intraepithelial lesion: 1.1%, high-grade squamous intraepithelial lesion or more serious lesions: 0.4%), but varied substantially among laboratories. The prevalence of atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion increased significantly over time. Pathologists from Limburg have pioneered cytology registration in the context of opportunistic screening in Belgium. The estimated screening coverage was slightly underestimated. Obligatory registration, use of a uniform terminology and linkage with population and follow-up data are needed to give a cytology registry its full role in an organized screening programme.

Squamous Intraepithelial Lesions Arising in Benign Endocervical Polyps: A Report of 9 Cases With Correlation to the Pap Smears, HPV Analysis, and Immunoprofile

Endocervical polyps are common benign lesions that typically arise in the endocervical canal of women from 40 to 60 years old. The reported incidence of squamous intraepithelial lesion (SIL) occurring in an endocervical polyp is typically less than 1/1,000 (0.1%). We report on 9 cases of SIL arising in otherwise classic benign endocervical polyps; these lesions were from a pool of about 1500 endocervical polyps for an incidence of approximately 0.5%. Five cases were low-grade SIL; of the 4 cases of high-grade SIL, 1 was associated with an invasive squamous cell carcinoma. In 8/9 cases, there was no evidence of SIL on colposcopic examination or biopsy of the remainder of the cervix. There were 12 Pap smears (either concurrent or from 6 mo to 2 yr before the biopsy-proven SIL) taken from the 9 women and most (10/12%-83%) were diagnosed as normal (7), atypical squamous cells of undetermined significance (ASCUS), favor reactive changes (1), or ASCUS (2) whereas the other 2 (17%) smears were diagnosed as low-grade SIL. Human papillomavirus DNA was evident in 7/8 (88%) of the polyps with SIL as determined by in situ hybridization. We conclude that cervical SILs can occur de novo in endocervical polyps, their incidence may be increasing, and, due to their presence in the endocervical canal, where they are much less accessible to sampling with a cytobrush/spatula, may not be evident in the Pap smear.

Squamous Intraepithelial Lesions Arising in Benign Endocervical Polyps: A Report of 9 Cases With Correlation to the Pap Smears, HPV Analysis, and Immunoprofile

Endocervical polyps are common benign lesions that typically arise in the endocervical canal of women from 40 to 60 years old. The reported incidence of squamous intraepithelial lesion (SIL) occurring in an endocervical polyp is typically less than 1/1,000 (0.1%). We report on 9 cases of SIL arising in otherwise classic benign endocervical polyps; these lesions were from a pool of about 1500 endocervical polyps for an incidence of approximately 0.5%. Five cases were low-grade SIL; of the 4 cases of high-grade SIL, 1 was associated with an invasive squamous cell carcinoma. In 8/9 cases, there was no evidence of SIL on colposcopic examination or biopsy of the remainder of the cervix. There were 12 Pap smears (either concurrent or from 6 mo to 2 yr before the biopsy-proven SIL) taken from the 9 women and most (10/12%-83%) were diagnosed as normal (7), atypical squamous cells of undetermined significance (ASCUS), favor reactive changes (1), or ASCUS (2) whereas the other 2 (17%) smears were diagnosed as low-grade SIL. Human papillomavirus DNA was evident in 7/8 (88%) of the polyps with SIL as determined by in situ hybridization. We conclude that cervical SILs can occur de novo in endocervical polyps, their incidence may be increasing, and, due to their presence in the endocervical canal, where they are much less accessible to sampling with a cytobrush/spatula, may not be evident in the Pap smear.

Increased Risk of Cervical Dysplasia in Long-Term Survivors of Allogeneic Stem Cell Transplantation—Implications for Screening and HPV Vaccination

As more women survive allogeneic stem cell transplantation (SCT), the development of genital human papilloma virus (HPV)-related squamous intraepithelial lesions (SIL) warrants study. Thirty-five of 38 females followed prospectively long-term after SCT for hematological malignancies (median: 7 years posttransplant) were adults and had cervical cytology testing. Acute graft-versus-host-disease (aGVHD) occurred in 9 and chronic (cGVHD) in 34 patients. Six (17%) continued receiving systemic immunosuppressive therapy (IST) for cGVHD >3 years after SCT. Of 15 (43%) with abnormal cytology, 12 (34%) patients had HPV-related SIL (median time to SIL 51 months, range: 22-108) including high-grade SIL in 7 (20%). Patients requiring continued IST had the highest risk (odds ratio [OR] 4.6, 95% confidence interval [CI] 1.1-16.4; P = .019). This high incidence of SIL in long-term SCT survivors underscores the importance of gynecologic assessment after transplantation, especially in those requiring IST. This may portend an increased risk of genital or other HPV-related malignancies.

Highly active antiretroviral therapy and incidence of cervical squamous intraepithelial lesions among HIV-infected women with normal cytology and CD4 counts above 350 cells/mm3

To provide evidence for the long-term effect of highly active antiretroviral therapy (HAART) on the incidence of cervical squamous intraepithelial lesions (SILs) among HIV-positive women with normal cytology test and CD4 count above 350 cells/mm(3). A retrospective cohort study was carried out in HIV-positive women with two consecutive normal cervical cytological tests (Papanicolaou test) and at least one subsequent test, without previous cervical history of SIL or cancer diagnosis, and with an immunological status >350 CD4 cells/mm(3). The patients were divided into two groups: treated with HAART (HAART group) or not treated with HAART (NO-HAART group), during the period of time between cytology tests included in the survival analysis and time until SIL. Between January 1997 and December 2006, 127 women were included: 90 in the HAART group and 37 in the NO-HAART group. Both groups of patients were similar with respect to demographic data, except for HIV viral load and previous HAART inclusion (P < 0.001). SIL was diagnosed in 27 of 90 (30%) patients in the HAART group and in 7 of 37 (19%) patients in the NO-HAART group (OR = 1.84, 95% CI: 0.72-4.69, P = 0.202). The actuarial probability of remaining free of SIL at 3 years was 70% in the HAART group and 78% in the NO-HAART group. No variable was associated with an increased risk of developing SILs. These results suggest that when the patients' immunological status is above 350 CD4 cells/mm(3), the HIV-infected women treated with HAART present a similar cervical SIL incidence to women not on HAART.

Evolution of Cervical Cytologic Changes among HIV-Infected Women with Normal Cytology in the HAART Era

The influence of HAART on the evolution to cervical squamous intraepithelial lesions (SIL) among HIV(+) women with a normal cytological test in the HAART era was studied. A retrospective cohort study (1997-2005) of HIV-infected women treated with HAART was conducted. Those with a normal cervical cytology (Papanicolaou test) and at least one subsequent test were included. Survival (time until diagnosis of SIL), univariate, and multivariate analyses were performed. A total of 133 HIV-infected patients treated with HAART were included. The incidence of SIL was 35% (47 patients). SIL was diagnosed in 36 of 110 (33%) patients with a baseline and final immunological status of >200 CD4 cells/microl and in 6 of 9 (67%) patients with a baseline and final immunological status of < or =200 CD4 (OR: 0.24, 95% CI: 0.06-1.03, p = 0.041). SIL was diagnosed in 10 of 60 (17%) patients with an undetectable baseline and final HIV viral load and in 36 of 70 (51%) patients with a detectable HIV viral load (OR: 0.19, 95% CI: 0.07-0.46, p < 0.001). A high incidence of SIL (cancer precursor lesions) was observed among HIV(+) women without a background of cervical pathology. The effect of HAART on the control of HIV replication and of immunological status (>200 CD4) through the follow-up was associated with a reduction of SIL.

Limited Impact of Immunosuppression and Haart on the Incidence of Cervical Squamous Intraepithelial Lesions in HIV-Positive Women

Although highly active antiretroviral therapy (HAART) has lowered the incidence of various opportunistic diseases, its impact on cervical squamous intraepithelial lesions (SILs) is unclear. Our objective was to compare the incidence of SILs in HIV-infected women receiving HAART versus those not receiving HAART and to determine the role of risk factors including immunosuppression in the pathogenesis of SIL. A total of 298 HIV-infected women with normal Papanicolaou (Pap) smear and normal colposcopic findings at enrollment were followed-up until incident SIL or last follow-up visit. Cox regression modelling was used to assess risks factors for incident SIL. Eighty-eight women developed SILs, including 75 low-grade lesions, during a median follow-up of 28 months (16-52; incidence of 8.7 cases per 100 person-years). No invasive cervical cancers were identified. Incidence decreased from 10.7 to 6.5 per 100 person-years in non-receiving versus receiving HAART women (relative risk [RR]: 0.7; 95% confidence interval [CI]: 0.4-1.2, P=0.15, from the adjusted Cox model). Incident SIL was not associated to low CD4+ T-cell count (P=0.54). In multivariate analysis, the only significant risk factor for incident lesion was the age between 30-39 compared with over 40 (RR: 3.5; 95% CI: 1.4-8.9; P=0.02). No impact in the development of SIL was evidenced for CD4+ T-cell counts, but we cannot exclude a modest impact of HAART. All HIV-positive women should be offered to participate in cervical cancer screening programmes whether or not they receive effective antiretroviral therapy.

Results of longterm hospital based cytological screening in asymptomatic women

Routine cytological screening has been carried out in 27,062 asymptomatic women attending Gynaec and Family Planning O.P.D. of Queen Mary's Hospital, Lucknow, India (April 1971-December 2004). Incidence of squamous intraepithelial lesion (SIL) was found to be 5.9% in the series, while cervical malignancy was seen in 0.6% of cases. The study highlighted the immense utility of cytological screening in minimizing the incidence of carcinoma cervix in the segment of the urban population screened, as the incidence dropped down to 0.5% in the second half from 1.1% noticed in the first half of the screening period. The study also emphasized the utility of clinically downstaging the cervical cancer as 7,316 women showing clinical lesions of cervix were found to harbor SIL in 15.3% and carcinoma cervix in 1.3% of cases as against the incidence of 2.5% for SIL and 0.6% for frank cancer in women with normal cervix. The investigation into different risk factors involved in cervical carcinogenesis revealed that the incidence of SIL and cancer cervix showed a rise with increasing age and parity and prolonged sexual period. The incidences of both cervical cytopathologies were also higher in women of low socio-economic status while religion was found to have no bearing on the occurrence of the disease. Among the four sexually transmitted diseases (STDs) diagnosed in the cervical smears, Trichomonas vaginalis was found to be more prevalent (2.6%), while human papillomavirus (HPV) and Herpes simplex was seen in 0.4 and 0.2% of cases, respectively Herpes simplex was found to have strong affinity with both SIL and carcinoma cervix, while only SIL incidence was high with HPV infection. The study emphasizes need of proper education to women of low socio-economic class for creating awareness regarding hazards and risk factors of cervical cancer as well as management and cure of the disease.

Atypical repair on Pap smears: Clinicopathologic correlates in 647 cases

The Bethesda system separates atypical reparative changes (ARC) from "typical" repair and places it into the atypical squamous cells of undetermined significance (ASC-US) category. The cytologic diagnosis of ARC represents both diagnostic and management challenges because its clinical significance is controversial and has not been fully investigated. On the basis of scant literature on follow-up of women with ARC on Papanicolaou (Pap) test, we reviewed data from our patient population, which consists of a mixture of low- and high-risk women. Six hundred forty-seven patients with ARC on their Pap tests were identified in a 7-yr period. Of this, 189 (29%) women were lost to follow-up. Of the 458 women with follow-up, 31% had cervical biopsies and 69% were followed by repeated Pap tests. The age ranged from 16 to 86 (mean 47 yr). The incidence of squamous intraepithelial lesion was 5.2% (5% low-grade and 0.2% high-grade). Most women (62%) with ARC on Pap test had a benign condition on follow-up. For some women, the immediate cause was not known and the Pap abnormality resolved spontaneously. Our study questions the validity of reporting ARC within the ASC-US category.