Colposcopy, cytology and HPV-DNA testing in HIV-positive and HIV-negative women.
In this study we examined the incidence of colposcopic-colpocytologic findings and analyzed Human Papilloma Virus (HPV)-DNA testing by Polymerase Chain Reaction (PCR) in 104 Human Immunodeficiency Virus (HIV) serous positive women (Group 1) and 218 HIV-negative women (control Groups 2 and 3). The aim of the study was to evaluate the most appropriate and efficacious diagnostic methods for screening programs for cervical cancer in HIV-positive women. For Group 1 we also considered the value of CD4+ T-lymphocytes and morphologic and molecular follow-up from 3 to 6 months. The results showed that the abnormal transformation zone (ANTZ) was present in 66.3% of the cases in Group 1 compared with 31.4% in control-Group 2 (p<0.001), and with 58.93% of the cases in control-Group 3 (p=0.257); intraepithelial squamous lesions (SIL) were found in 50% vs 5.66% (p<0.001) and vs 56.25% of the cases (p=0.433), respectively. In 28.85% of the HIV-positive patients the first cytological screening exam was not evaluable due to inflammation but in 56.67% of the cases colposcopy revealed ANTZ. The subsequent colpocytological checkup after therapy showed 10 cases (30%) of low risk squamous intraepithelial lesions (LSIL) and two cases (6.6%) of high risk squamous intraepithelial lesions (HSIL). HPV-DNA testing by PCR was positive in 53.8% of the cases in Group 1, in 6.6% in control-Group 2 and in 42% in control-Group 3. In HIV-positive patients multiple HPV genotypes were simultaneously present in 21.43% of the cases and high risk genotypes were present in 70% of the cases of HSIL. In Group 1, 36.61% of the cases had lesions of the lower genital tract. The value of CD4+ T-lympocytes was <200 cells/ml in 30% of the cases of HSIL. Our data, like those of other Authors, confirm a high incidence of HSIL, abnormal colposcopic findings, and HPV infections in HIV-positive women with respect to control-Group 2, while there was not much difference between Group 1 and control-Group 3. Such frequency again suggests that an integrated morphological diagnostic approach with colposcopy-colpocytology in the screening of immunosuppressed subjects would be worthwhile.
Torrisi
A
A
Institute of Gynaecology and Obstetrics, University of Padua, Italy.
Del Mistro
A
A
Onnis
G L
GL
Merlin
F
F
Bertorelle
R
R
Minucci
D
D
D000328:Adult; D002277:Carcinoma / Q000175:diagnosis; D002584:Cervix Uteri / Q000166:cytology / Q000473:pathology*; D003127:Colposcopy / Q000379:methods*; D015897:Comorbidity; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D005500:Follow-Up Studies; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014412:Tumor Virus Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis
D004279:DNA, Viral