Is HIV infection associated with an increase in the prevalence of cervical neoplasia?
OBJECTIVE
To test the hypotheses: (1) that HIV infection predisposes to cervical intraepithelial neoplasia (CIN); (2) that this CIN is a result of HIV related immunosuppression; and (3) that this CIN is a result of immunosuppression causing increased expression of the potentially oncogenic viruses, human papilloma virus (HPV), Epstein Barr virus (EBV) and herpes simplex virus (HSV).


METHODS
A matched cross sectional study.


METHODS
The Department of Gynaecological Oncology, The Samaritan Hospital, London; the Department of Genitourinary Medicine, St Mary's Hospital, London; and the Family Planning Clinic, Claremont Terrace, Glasgow.


METHODS
Fifty HIV seropositive women enrolled from the Genitourinary Medicine Department and the Drug Dependency Unit at St Mary's Hospital, London, and the Unit of Infectious Diseases at Ruchill Hospital, Glasgow. Forty-three HIV seronegative controls enrolled from the Department of Genitourinary Medicine at St Mary's Hospital, matched against 43 of the seropositive women for age, age at first intercourse, lifetime number of sexual partners, and smoking habit.


METHODS
Associations between CIN, as detected by cytology and histology, and HIV infection. Association was also sought between CIN and immunosuppression, as measured clinically by T4 cell number, beta-2-microglobulin and p24 antigen. Associations of these with: (1) HPV, as detected by Southern blot testing and the polymerase chain reaction; (2) EBV, as detected by Southern blot testing; and (3) HSV, as detected by tissue culture of endocervical swabs, was also studied.


RESULTS
There was no significant difference in the prevalence of CIN or oncogenic viruses between HIV seropositive and seronegative women in the absence of immunosuppression. If the HIV infected women showed signs of immunosuppression, the prevalence of CIN was increased. No association was shown between detection of HPV, EBV and HSV and immunosuppression or CIN.


CONCLUSIONS
HIV infection may only be associated with an increased risk of CIN when immunosuppression is present.
Smith
J R
JR
Department of Obstetrics and Gynaecology, Charing Cross and Westminster Medical School, London, UK.
Kitchen
V S
VS
Botcherby
M
M
Hepburn
M
M
Wells
C
C
Gor
D
D
Forster
S M
SM
Harris
J R
JR
Steer
P
P
Mason
P
P
D000328:Adult; D000367:Age Factors; D002278:Carcinoma in Situ / Q000209:etiology* / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000276:immunology; D006801:Humans; D007108:Immune Tolerance; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012747:Sexual Partners; D012907:Smoking; D002583:Uterine Cervical Neoplasms / Q000209:etiology* / Q000473:pathology; D014626:Vaginal Smears