Genital dysplasia in women infected with human immunodeficiency virus.
BACKGROUND
Women infected with human immunodeficiency virus (HIV) are at increased risk for the development of dysplastic genital lesions. Traditionally, markers of immunosuppression were predictive of the development of dysplasia. Recent advances in antiretroviral medications allow restoration of a once-depressed CD4+ cell count and suppression of HIV replication. In this new era, additional predictive markers of genital dysplasia are needed for management of women infected with with HIV.


OBJECTIVE
To find predictive markers of genital dysplasia in women infected with HIV.


METHODS
Observational study of a consecutive sample of 200 women infected with HIV from an urban university clinic. Measurements of histopathology, CD4+ count, CD4+ nadir, HIV viral load, human papillomavirus (HPV), and usage of highly active antiretroviral therapy (HAART) were evaluated for an association with genital dysplasia.


RESULTS
There was a trend toward a protective effect against any genital dysplasia when HAART had been prescribed [relative risk = 0.77, 95% confidence interval (CI) 0.56, 1.06] and HAART therapy resulted in an immune response (relative risk, 0.61; 95% CI, 36, 1.02). High-risk HPV DNA was a strong predictor of dysplasia (P =.0003). A lower CD4+ count nadir was strongly associated with genital dysplasia (P =.0003).


CONCLUSIONS
A history of greater immunosuppression, as measured by the nadir of a patient's CD4+ count, is the strongest predictor of genital dysplasia in women infected with HIV.
Taylor
Gregory
G
Department of Family Medicine, University of Maryland, Baltimore, MD 21201, USA.
Wolff
Tracy
T
Khanna
Niharika
N
Furth
Priscilla
P
Langenberg
Patricia
P
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000276:immunology; D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications* / Q000276:immunology; D012307:Risk Factors; D002578:Uterine Cervical Dysplasia / Q000150:complications* / Q000276:immunology / Q000517:prevention & control / Q000821:virology; D019562:Viral Load
D015415:Biomarkers