title: Squamous intraepithelial lesions in HIV-infected women: prevalence, incidence, progression and regression.
abstract: OBJECTIVE
  To evaluate the impact of HIV immune depletion, highly active antiretroviral therapy (HAART) and patient characteristics on the occurrence of cervical squamous intraepithelial lesions (SIL).
  
  
  METHODS
  A total of 898 HIV-positive women were evaluated at the time of their first Pap smear and 388 of them received additional Pap smears during follow-up in a cohort study. The patients were enrolled from July 1997 to April 2007. Prevalence and incidence of SIL in Pap smears were studied. Progression and regression were evaluated in follow-up of patients presenting low-grade SIL.
  
  
  RESULTS
  Pap smear results at baseline were: 741 normal (82.5 %), 56 atypical squamous cells of indeterminate significance (ASCUS) (6.2 %), 78 low-grade SIL (8.7 %), 22 high-grade SIL (2.4 %), and 1 invasive cervical cancer (0.1 %). SIL cumulative incidence rate was 9.7 %. Progression and regression occurred in 15.9 and 62 %, respectively. Multivariate analysis of CD4 counts ≤ 200 cells/mm(3) (aHR = 2.1; 95 % CI 1.3-3.5; P = 0.004) and age less than 30 years (aHR = 3.2; 95 % CI 1.5-6.8; P = 0.01) or less than 40 years old (aHR = 2.6; 95 % CI 1.2-5.7; P = 0.01) were significantly associated with SIL prevalence. CD4 counts ≤ 200 cells/mm(3) (aHR = 3.0; 95 % CI 1.2-7.2; P = 0.01) and higher viral load counts (for each log increase) were associated with SIL incidence (aHR = 1.4; 95 % CI 1-1.9; P = 0.048).
  
  
  CONCLUSIONS
  Prevalence and incidence of SIL in HIV-positive women were associated with severity of HIV disease. Interventions to increase access to Pap smears and further diagnostic tests should be implemented and targeted to HIV-positive women.
authors: Health Municipal Department, Center for STD/AIDS Treatment, Porto Alegre, RS, Brazil, regis.kr@terra.com.br.
authors: Regis
authors: R
authors: Kreitchmann
authors: Halim
authors: H
authors: Bajotto
authors: Daila Alena Raenck
authors: DA
authors: da Silva
authors: Sandra Costa
authors: SC
authors: Fuchs
mesh_terms: D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D015994:Incidence; D060787:Neoplasm Grading; D009365:Neoplasm Regression, Spontaneous; D018307:Neoplasms, Squamous Cell / Q000453:epidemiology* / Q000473:pathology*; D065006:Papanicolaou Test; D015995:Prevalence; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D014626:Vaginal Smears; D019562:Viral Load; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000473:pathology*