title: Cervical squamous intraepithelial lesions in HIV-infected women: prevalence, incidence and regression. European Study Group on Natural History of HIV Infection in Women.
abstract: OBJECTIVE
  To assess the impact of HIV-related immunodeficiency and antiretroviral treatment on the occurrence and evolution of abnormal Papanicolaou tests.
  
  
  METHODS
  Cohort of 485 HIV-infected women with a known date of infection, enrolled during May 1993-April 1998 in 23 centres (gynaecology, infectious disease or STD clinics, or drug treatment centres) in 12 European countries; in 21 centres, follow-up was performed every 6 months (median follow-up: 2 years).
  
  
  METHODS
  Human papillomavirus (HPV) was detected at inclusion by Southern blot and PCR. The prevalence of squamous intraepithelial lesions (SIL), the incidence of SIL and regression from low-grade SIL were studied according to CD4 count after controlling for HPV detection results.
  
  
  RESULTS
  Compared with women with CD4 cell counts > 500 x 10(6)/l, women with CD4 cell counts < 200 x 10(6)/l had a twofold increase in both prevalence and incidence of SIL and in non-regression from untreated low-grade SIL; in addition, these women had a lower response rate to treatment of high-grade cervical intraepithelial neoplasia. The increase in SIL incidence associated with a low CD4 cell count was significant in women not receiving antiretroviral treatment (relative risk, CD4 cell count 200-499 x 10(6)/l, 1.9; CD4 cell count < 200 x 10(6)/l, 2.9; CD4 cell count > 500 x 10(6)/l, reference), whereas it was less marked and not statistically significant in treated women.
  
  
  CONCLUSIONS
  Severe HIV-related immunodeficiency strongly increases the risk of occurrence of SIL; antiretroviral treatment may reduce this risk, probably by restoring or at least preserving immune function.
authors.affiliation: European Centre for the Epidemiological Monitoring of AIDS, Saint-Maurice, France.
authors.forename: M C
authors.initials: MC
authors.lastname: Delmas
authors.forename: C
authors.initials: C
authors.lastname: Larsen
authors.forename: B
authors.initials: B
authors.lastname: van Benthem
authors.forename: F F
authors.initials: FF
authors.lastname: Hamers
authors.forename: C
authors.initials: C
authors.lastname: Bergeron
authors.forename: J D
authors.initials: JD
authors.lastname: Poveda
authors.forename: B
authors.initials: B
authors.lastname: Anzén
authors.forename: A
authors.initials: A
authors.lastname: van den Hoek
authors.forename: F
authors.initials: F
authors.lastname: Meier
authors.forename: J M
authors.initials: JM
authors.lastname: Peña
authors.forename: H
authors.initials: H
authors.lastname: Savonius
authors.forename: D
authors.initials: D
authors.lastname: Sperandeo
authors.forename: B
authors.initials: B
authors.lastname: Suligoi
authors.forename: P
authors.initials: P
authors.lastname: Vernazza
authors.forename: J B
authors.initials: JB
authors.lastname: Brunet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D018307:Neoplasms, Squamous Cell / Q000453:epidemiology* / Q000276:immunology; D027383:Papillomaviridae / Q000276:immunology / Q000302:isolation & purification; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000276:immunology; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000276:immunology