[Intraepithelial cervical carcinoma and HIV. Prevalence, risk factors and prevention strategies].
BACKGROUND
The present study analyses cervical dysplastic lesions associated with HIV infection by means of cytological, colposcopic and histologic examinations, and the diagnostic accuracy of the Pap test.


METHODS
Cross-sectional study. We have studied colposcopic and histologic findings of 115 HIV-positive women. In 86 patients a cytological examination was also carried out. The results were compared with those of a control group consisting of 127 HIV-negative women in pre-menopause age.


RESULTS
The prevalence of cervical dysplastic lesions present at colposcopic/bioptic examination was 3.2 times greater in HIV+ women than in HIV- women (38% vs 12%, p<0.001) and that of lesions of a higher degree 7 times greater. Compared to non-HIV+ women, patients who were positive presented more severe dysplastic lesions, a higher frequency of HPV-derived lesions and inflammatory pictures. There was also a correlation between high incidence of dysplastic cervical lesions and advanced stage of immunodepression. The negative predictive value of the Pap test was higher in the seronegatives (95%) than in the seropositives (83%, p<0.01). The overall agreement between cytology and colposcopy/histology was greater in the seronegati-ves than in the seropositives (87% vs 74%, p<0.05).


CONCLUSIONS
Cervical dysplastic lesions in seropositive patients are more frequent and aggressive than in HIV negatives and are related both to the degree of immunodepression and to the HPV infection. Further, the diagnostic value of the Pap test in association with HIV is reduced. These results suggest that in HIV+ patients careful combined cytological-colposcopic screening should be adopted, together with an attentive cyto-colposcopic follow-up in treated patients.
Soncini
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Dipartimento di Scienze Ginecologiche, Ostetriche e di Neonatologia, Università degli Studi di Parma, Parma, Italy. soncio@tin.it
Condemi
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D000328:Adult; D001706:Biopsy; D018791:CD4 Lymphocyte Count; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D003127:Colposcopy; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D018023:HIV Seronegativity; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D016017:Odds Ratio; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology; D010298:Parity; D015995:Prevalence; D012307:Risk Factors; D014412:Tumor Virus Infections / Q000150:complications / Q000453:epidemiology; D002578:Uterine Cervical Dysplasia / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D002575:Uterine Cervicitis / Q000150:complications / Q000453:epidemiology / Q000821:virology