title: Screening for cervical carcinoma in HIV-infected women: Analysis of main risk factors for cervical cytologic abnormalities.
abstract: OBJECTIVE
  The aim of this study was to identify potential predictive factors for cervical disease in women with HIV and to evaluate adherence during follow-up to cervical cancer screening.
  
  
  METHODS
  In order to identify the independent role of factors associated with the presence of a cervical abnormality, all of the variables showing in univariate analyses a potential association with the outcome variable (presence of cervical abnormalities) were entered into a multivariate logistic regression model, along with age at first visit to our center, and age at diagnosis.
  
  
  RESULTS
  A total of 540 HIV-positive women who received screening for cervical cancer during the first year after their first visit to our center were included in the analysis; 423 (78.3%) had normal cytology and 117 (21.7%) had cytological abnormalities, classified as follows: 21 atypical squamous cells of undetermined significance (17.9%); 51 low-grade squamous intraepithelial lesions (43.6%); 41 high-grade squamous intraepithelial lesions (35.0%); and four cervical cancers (3.4%). In our study, women with more than two previous pregnancies were significantly associated with a lower risk of cervical cytological abnormalities compared to the other women. Women with CD4+ levels of 200-499/mm3had a higher risk of developing cervical cytological abnormalities compared to those with a CD4+ level > 500/ mm3.
  
  
  CONCLUSIONS
  In summary, management of HIV-positive women must be modeled on HIV-clinical status, CD4+ cell count, drug regimen, and adherence to follow-up, relying on the cooperation of highly qualified professionals. In HIV-positive women, an adequate screening and follow-up allows for a reduced occurrence of advanced cervical disease and prevents recourse to invalidating surgical interventions.
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Naples, Italy.
authors.forename: Matilde
authors.initials: M
authors.lastname: Sansone
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Naples, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Saccone
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Naples, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Migliucci
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Naples, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Saviano
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Naples, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Capone
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Naples, Italy.
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Maruotti
authors.affiliation: Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Bruzzese
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Naples, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Martinelli
mesh_terms: D000328:Adult; D015897:Comorbidity; D055088:Early Detection of Cancer / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology
keywords: HIV; cervical cancer; colposcopy; highly active antiretroviral therapy; screening