High prevalence of cervical squamous cell abnormalities among HIV-infected women with immunological AIDS-defining illnesses.
OBJECTIVE
To assess the results of Pap smear at postpartum scheduled visit, especially the prevalence of squamous cell abnormalities including association with CD4(+) T-lymphocyte count (CD4(+) count) levels at delivery among HIV-infected women between the years 1996 and 2004.


METHODS
As part of the research and implementation programs of short course antiretroviral regimens for the prevention of mother to child perinatal HIV transmission in HIV-infected pregnant women delivered at Siriraj hospital, CD4(+) count at delivery and Pap smear at postpartum were evaluated.


RESULTS
Among 636 women, 13.3% had squamous cell abnormalities. Seventy-seven cases (90.6%) of squamous cell abnormalities were low grade squamous intraepithelial lesions. The prevalence of squamous epithelial cell abnormalities detected by Pap smear, was higher in women whose CD4(+) count at delivery was < 200 cells/microL than in women whose CD4(+) count at delivery was > or = 200 cells/microL, with a significant difference (21.2%vs 12.2%).


CONCLUSIONS
All HIV-infected pregnant women should be evaluated for clinical and immunological status during the antepartum period. Pelvic examination and Pap smear should be considered as a part of this evaluation. They should receive comprehensive health-care services that continue after pregnancy, including postpartum gynecologic examination and Pap smear. Women with normal cervical cytological findings but low CD4(+) count should be offered an antenatal Pap smear and long-term follow-up including a 6-monthly Pap smear.
Chalermchockcharoenkit
Amphan
A
Female Sexually Transmitted Diseases Unit, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand. siacl@mahidol.ac.th
Sirimai
Korakot
K
Chaisilwattana
Pongsakdi
P
D018791:CD4 Lymphocyte Count; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D065006:Papanicolaou Test; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D015995:Prevalence; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000473:pathology / Q000821:virology