title: Factors associated with colposcopy-histopathology confirmed cervical intraepithelial neoplasia among HIV-infected women from Rio De Janeiro, Brazil.
abstract: BACKGROUND
  Despite the availability of preventive strategies (screening tests and vaccines), cervical cancer continues to impose a significant health burden in low- and medium-resourced countries. HIV-infected women are at increased risk for infection with human papillomavirus (HPV) and thus development of cervical squamous intraepithelial neoplasia (CIN).
  
  
  METHODS
  Study participants included HIV-infected women enrolling the prospective open cohort of Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation (IPEC/FIOCRUZ). At cohort entry, women were subjected to conventional Papanicolaou test, HPV-DNA test and colposcopy; lesions suspicious for CIN were biopsied. Histopathology report was based on directed biopsy or on specimens obtained by excision of the transformation zone or cervical conization. Poisson regression modeling was used to assess factors associated with CIN2+ diagnosis.
  
  
  RESULTS
  The median age of the 366 HIV-infected women included in the study was 34 years (interquartile range: 28-41 years). The prevalence of CIN1, CIN2 and CIN3 were 20.0%, 3.5%, and 2.2%, respectively. One woman was found to have cervical cancer. The prevalence of CIN2+ was 6.0%. Factors associated with CIN2+ diagnosis in the multivariate model were age < years compared to ≥ 35 years (aPR  =  3.22 95%CI 1.23-8.39), current tobacco use (aPR  =  3.69 95%CI 1.54-8.78), nadir CD4 T-cell count <350 cells/mm3 when compared to ≥ 350 cells/mm3 (aPR  =  6.03 95%CI 1.50-24.3) and concomitant diagnosis of vulvar and/or vaginal intraepithelial lesion (aPR  =  2.68 95%CI 0.99-7.24).
  
  
  CONCLUSIONS
  Increased survival through wide-spread use of highly active antiretroviral therapy might allow for the development of cervical cancer. In Brazil, limited cytology screening and gynecological care adds further complexity to the HIV-HPV co-infection problem. Integrated HIV care and cervical cancer prevention programs are needed for the prevention of cervical cancer mortality in this group of women.
authors.affiliation: Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
authors.forename: Angela Cristina Vasconcelos
authors.initials: AC
authors.lastname: de Andrade
authors.forename: Paula Mendes
authors.initials: PM
authors.lastname: Luz
authors.forename: Luciane
authors.initials: L
authors.lastname: Velasque
authors.forename: Valdiléa Gonçalves
authors.initials: VG
authors.lastname: Veloso
authors.forename: Ronaldo I
authors.initials: RI
authors.lastname: Moreira
authors.forename: Fabio
authors.initials: F
authors.lastname: Russomano
authors.forename: Janice
authors.initials: J
authors.lastname: Chicarino-Coelho
authors.forename: Elaine
authors.initials: E
authors.lastname: Pires
authors.forename: José Eduardo
authors.initials: JE
authors.lastname: Levi
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.forename: Ruth Khalili
authors.initials: RK
authors.lastname: Friedman
mesh_terms: D000328:Adult; D001519:Behavior; D001938:Brazil / Q000453:epidemiology; D003127:Colposcopy; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000473:pathology*; D006801:Humans; D015995:Prevalence; D015203:Reproducibility of Results; D002578:Uterine Cervical Dysplasia / Q000150:complications* / Q000453:epidemiology / Q000473:pathology* / Q000821:virology