Cervical dysplasia in women infected with the human immunodeficiency virus (HIV): a correlation with HIV viral load and CD4+ count.
OBJECTIVE
The incidence of cervical dysplasia and carcinoma is known to be increased in HIV-infected women. In addition, there is a positive correlation between HIV viral load (VL), CD4+ count, and opportunistic infections, as well as the incidence of various malignancies. This study compares HIV VL and CD4+ count with the presence of cervical dysplasia, as well as with the degree of severity of dysplasia.


METHODS
A retrospective chart review of 350 HIV-infected women with polymerase chain reaction (PCR) quantitation of viral load was performed to identify 82 women with biopsy-proven cervical dysplasia and 25 women without any significant cervical pathology. The highest plasma VL within a year of the patients' cervical pathology and corresponding CD4+ count was selected and compared with cervical pathology. Univariate and multivariate statistical analysis using Student's t test and logistic regression analysis was used to analyze the significance of other risk factors such as age, race, smoking history, history of illicit drug use, and prior sexually transmitted disease as well as of viral load and CD4+ count.


RESULTS
Of 82 cases of cervical dysplasia, 33 (40.24%) were mild (CIN I), 47 (57.32%) were either moderate or severe (CIN II-III) dysplasia, and 2 demonstrated invasive squamous cell carcinoma (2.44%). A significant statistical difference was found when comparing either HIV plasma VL or CD4+ T-cell counts with the presence of cervical dysplasia on biopsy (P < 0.005). However, only CD4+ count was identified as an independent risk factor for the presence of cervical dysplasia after multivariate analysis.


CONCLUSIONS
In our population, there is a significant correlation between VL and CD4+ count and the presence of cervical dysplasia. However, VL does not appear to be an independent risk factor for cervical dysplasia in this population of HIV-infected women.
Department of Pathology and Laboratory Medicine, Emory University, Grady Memorial Hospital, Atlanta, Georgia 30335, USA.
A T
AT
Davis
H
H
Chakraborty
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L
Flowers
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MB
Mosunjac
D000293:Adolescent; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology / Q000276:immunology*; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000276:immunology / Q000821:virology*; D005260:Female; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000097:blood* / Q000150:complications / Q000276:immunology*; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D012367:RNA, Viral / Q000097:blood; D012044:Regression Analysis; D012189:Retrospective Studies; D002578:Uterine Cervical Dysplasia / Q000097:blood / Q000276:immunology / Q000821:virology*; D002583:Uterine Cervical Neoplasms / Q000097:blood / Q000276:immunology / Q000821:virology*; D019562:Viral Load
D012367:RNA, Viral