title: Prevalence and risk factors of squamous intraepithelial lesions of the cervix among HIV-infected women - a long-term follow-up study in a low-prevalence population.
abstract: HIV-infected women have high risk for precancerous lesions of the uterine cervix. We studied the prevalence and risk factors of squamous intraepithelial lesions (SIL) among systematically followed HIV-infected women enrolled from a population with low HIV prevalence. The study population consisted of 108 HIV-infected women enrolled between 1989 and 2003 with a mean follow-up 4.4 years. Risk factors of SIL were assessed based on samples collected during 2000-02. The overall rates of atypical glandular cells of uncertain significance (AGUS), atypical squamous cells of uncertain significance (ASCUS), low-grade SIL (LSIL) and high-grade SIL (HSIL) were 4, 24, 15 and 5%, respectively. Reduced CD4-lymphocyte count was associated with an increased prevalence of SIL, whereas duration of HIV infection (< or > or =5 years), use of antiretroviral medication, or HIV viral load (<50 or > or =50 copies/mL) was not. The cumulative risk of developing SIL after 1 and 5 years was 17% (95% confidence interval [CI] 7-27%) and 48% (95% CI 33-63%), respectively. The cumulative risk of SIL was increased among women younger than 31 years (P = 0.04) as well as in women displaying high initial HIV viral load (P = 0.01). Our results from a low HIV-incidence population re-emphasize the importance of guidelines for cytologic screening of HIV-seropositive women.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Helsinki, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Lehtovirta
authors.forename: Patrik
authors.initials: P
authors.lastname: Finne
authors.forename: Pekka
authors.initials: P
authors.lastname: Nieminen
authors.forename: Kirsi
authors.initials: K
authors.lastname: Skogberg
authors.forename: Hannele
authors.initials: H
authors.lastname: Savonius
authors.forename: Jorma
authors.initials: J
authors.lastname: Paavonen
authors.forename: Oskari
authors.initials: O
authors.lastname: Heikinheimo
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents; D002584:Cervix Uteri / Q000473:pathology*; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology
chemical_list: D044966:Anti-Retroviral Agents