Cervical squamous intraepithelial lesions in HIV-infected women: prevalence, incidence and regression. European Study Group on Natural History of HIV Infection in Women.
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.
Delmas
M C
MC
European Centre for the Epidemiological Monitoring of AIDS, Saint-Maurice, France.
Larsen
C
C
van Benthem
B
B
Hamers
F F
FF
Bergeron
C
C
Poveda
J D
JD
Anzén
B
B
van den Hoek
A
A
Meier
F
F
Peña
J M
JM
Savonius
H
H
Sperandeo
D
D
Suligoi
B
B
Vernazza
P
P
Brunet
J B
JB
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