title: Cellular immunodeficiency enhances the progression of human papillomavirus-associated cervical lesions.
abstract: Most cases of low-grade cervical intraepithelial neoplasia (CIN) associated with oncogenic human papillomavirus (HPV) types regress spontaneously within years. Unknown co-factors seem to be necessary for a progression to malignancy. To determine the possible role of cellular immunodeficiency as such a co-factor in the genesis of genital neoplasia, 48 HIV-infected women and 52 allograft recipients were examined periodically during a 3-year period. Colposcopy, cytology and HPV-DNA typing (ViraType) were performed at each visit. Each cervical lesion was matched prospectively with 2 lesions from immunocompetent controls. In all, 29/100 patients suffered from cervical neoplasms, including 2 advanced cervical cancers and 9 CIN3 lesions. Correlation between grade of lesion and HPV DNA 16/18 was significant. Low-grade lesions among patients progressed more often than among controls and recurrent lesions after destructive treatment were seen more frequently among patients than among controls. All patients with CD4-lymphocyte counts of < 400/microliters or immunosuppression for more than 3 years suffered from progressive lesions. We conclude that malfunction of the cellular immune response following either HIV-induced depletion or iatrogenic inhibition of CD4-lymphocyte activation, enhances the progression of HPV-induced cervical lesions to malignancy.
authors.affiliation: Abt. für Gynäkologische Onkologie, Medizinische Hochschule, Hannover, Germany.
authors.forename: K U
authors.initials: KU
authors.lastname: Petry
authors.forename: D
authors.initials: D
authors.lastname: Scheffel
authors.forename: U
authors.initials: U
authors.lastname: Bode
authors.forename: T
authors.initials: T
authors.lastname: Gabrysiak
authors.forename: H
authors.initials: H
authors.lastname: Köchel
authors.forename: E
authors.initials: E
authors.lastname: Kupsch
authors.forename: M
authors.initials: M
authors.lastname: Glaubitz
authors.forename: S
authors.initials: S
authors.lastname: Niesert
authors.forename: H
authors.initials: H
authors.lastname: Kühnle
authors.forename: I
authors.initials: I
authors.lastname: Schedel
mesh_terms: D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007958:Leukocyte Count; D027383:Papillomaviridae / Q000472:pathogenicity*; D030361:Papillomavirus Infections / Q000150:complications* / Q000276:immunology; D002583:Uterine Cervical Neoplasms / Q000276:immunology* / Q000473:pathology / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000821:virology
chemical_list: D004279:DNA, Viral