title: Comparative prevalence, incidence and short-term prognosis of cervical squamous intraepithelial lesions amongst HIV-positive and HIV-negative women.
abstract: OBJECTIVE
  To investigate the impact of HIV infection on the prevalence, incidence and short-term prognosis of squamous intraepithelial lesions (SIL), in a prospective study with 1-year follow-up.
  
  
  METHODS
  Between 1993 and 1995, 271 HIV-positive and 171 HIV-negative women at high risk of HIV infection were recruited, 365 (82.6%) of whom completed the 1-year follow-up. The women underwent a Papanicolaou smear test at inclusion and at 6 and 12 months. Human papillomavirus (HPV) was detected at inclusion by Southern blot and PCR.
  
  
  RESULTS
  The SIL prevalence ranged from 7.5% for HIV-negative to 31.3% for HIV-positive women with CD4 cell counts < 500 x 10(6)/l (P < 0.001). Other factors associated independently and significantly with SIL prevalence were HPV-16, 18, 33 and related types, HPV-31, -35, -39 and related types, lifetime number of partners, younger age, past history of SIL and lack of past cervical screening. The SIL incidence ranged from 4.9% in HIV-negative women to 27% in HIV-positive women with CD4 cells < 500 x 10(6)/l (P < 0.001). Progression from low- to high-grade SIL during follow-up was detected in 38.1% of HIV-positive women with CD4 cells < or = 500 x 10(6)/l but in no HIV-negative nor HIV-positive women with CD4 cells > 500 x 10(6)/l. HPV-16, 18, 33 and related types were also associated with higher incidence of SIL and progression from low- to high-grade SIL.
  
  
  CONCLUSIONS
  HIV-induced immunodeficiency is associated with high prevalence, incidence and persistence/progression of SIL. A pejorative influence of HIV infection without marked immunodeficiency is less clear. HIV-positive women with SIL may thus benefit from early treatment when a useful immune response is still present.
authors.affiliation: European Centre for the Epidemiological Monitoring of AIDS, Saint-Maurice, France.
authors.forename: C
authors.initials: C
authors.lastname: Six
authors.forename: I
authors.initials: I
authors.lastname: Heard
authors.forename: C
authors.initials: C
authors.lastname: Bergeron
authors.forename: G
authors.initials: G
authors.lastname: Orth
authors.forename: J D
authors.initials: JD
authors.lastname: Poveda
authors.forename: P
authors.initials: P
authors.lastname: Zagury
authors.forename: P
authors.initials: P
authors.lastname: Cesbron
authors.forename: C
authors.initials: C
authors.lastname: Crenn-Hébert
authors.forename: R
authors.initials: R
authors.lastname: Pradinaud
authors.forename: M
authors.initials: M
authors.lastname: Sobesky
authors.forename: C
authors.initials: C
authors.lastname: Marty
authors.forename: M L
authors.initials: ML
authors.lastname: Babut
authors.forename: J E
authors.initials: JE
authors.lastname: Malkin
authors.forename: A
authors.initials: A
authors.lastname: Odier
authors.forename: S
authors.initials: S
authors.lastname: Fridmann
authors.forename: J P
authors.initials: JP
authors.lastname: Aubert
authors.forename: J B
authors.initials: JB
authors.lastname: Brunet
authors.forename: I
authors.initials: I
authors.lastname: de Vincenzi
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D018307:Neoplasms, Squamous Cell / Q000150:complications* / Q000453:epidemiology*; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D002578:Uterine Cervical Dysplasia / Q000150:complications* / Q000453:epidemiology*