Cervical dysplasia and human immunodeficiency virus infection in women: prevalence and associated factors. Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GESCA).
OBJECTIVE
To study the prevalence of Cervical Intraepithelial Neoplasia (CIN) and its association with HIV-I infection, controlling for other risk factors of CIN.


METHODS
Cross-sectional survey.


METHODS
HIV-1 seropositive (HIV+) and seronegative (HIV-) women were enrolled at the Obstetrics-Gynecologic Departments of the Bordeaux University Hospital from April 1993 to June 1995. A gynecologic check-up was performed with a clinical examination, a colposcopy and a Papanicolaou smear. Sexually Transmitted Diseases (STDs) were screened. Colposcopy was interpreted as: normal, low-grade or high-grade lesions. Interpretation of Papanicolaou smears was based on the 1988 Bethesda system using three descriptive diagnoses: normal, low-grade and high-grade Squamous Intraepithelial lesions (SILs). If colposcopy showed a high grade lesion or Papanicolaou smear a high-grade SIL, a cervical biopsy was performed. Absence of CIN was defined by normal Papanicolaou smear and colposcopy. High grade CIN was defined by either identification of high grade SIL on Papanicolaou smear or high grade lesion on colposcopy confirmed by CIN2-3 lesion on biopsy. Other cases were classified as low-grade CIN. HPV infection was diagnosed on presence of koilocytosis on cytological or histological specimens.


RESULTS
Prevalence of CIN was significantly higher in the 128 HIV+ women than in the 102 HIV- women: 34.4% vs. 13.7% (O.R.=3.30). Among HIV+ women, 25.8% had low-grade CIN and 8.6% high-grade CIN versus 10.8% and 2.9%, respectively among the HIV- women. Prevalence of HPV infection was 50.0% among women with CIN vs. 5.8% in women without CIN (P= 10(-6)). In the multivariate analysis of the determinants of CIN, smoking more than ten pack-years and HPV infection were the only two variables associated with CIN while association with HIV infection disappeared. Among HIV+ women, the variables associated with CIN were clinical AIDS and HPV infection.
Hocke
C
C
Department of Obstetrics and Gynecology, Bordeaux University Hospital, France.
Leroy
V
V
Morlat
P
P
Rivel
J
J
Duluc
M C
MC
Boulogne
N
N
Tandonnet
B
B
Dupon
M
M
Brun
J L
JL
Dabis
F
F
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000293:Adolescent; D000328:Adult; D001706:Biopsy; D003127:Colposcopy; D003430:Cross-Sectional Studies; D005260:Female; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae; D030361:Papillomavirus Infections; D012907:Smoking; D014412:Tumor Virus Infections; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*