Cervical intraepithelial neoplasia and HPV infection in HIV/AIDS women attending an STI/AIDS clinic in Brazil
A. Miranda1, B. Lima1, L. Freitas1, L. Spano1, A. Mattos1, J. Golub2
1Universidade Federal do Espírito Santo, Medicina Social, Vitoria, Brazil, 2Johns Hopkins University, School of Medicine, Baltimore, United States
Background: Screening HIV-infected populations are an important public health service. Our goal was evaluating the prevalence of cervical intraepithelial neoplasia and Human Papillomavirus (HPV) infection in HIV-positive and HIV-negative women attending an STI clinic in Vitória, Brazil.
Methods: Women attending an STI clinic in Vitória between March and December 2006 for gynecological examination were invited to participate. Enrolled patients underwent a gynecological evaluation and cervical scrape samples were collected for cytological analysis and HPV-DNA PCR. A blood sample was obtained to determine HIV status.
Results: A total of 284 women agreed to participate; 112(39%) HIV-positives and 172(61%) HIV-negatives. Median age was 30 (interquartile range [IQR]:23-36) years and median years of education was 8(IQR:5-11). Median age at first sexual intercourse was 16 (IQR:15-18) years. There were no differences between HIV groups regarding age, education, age at first sexual intercourse, age of partner at first sexual intercourse, and number of sexual partners. Cervical screening revealed 222(78%) patients with normal cytology, 39(14%) with inflammatory disorders, 10(4%) with atypical squamous cells of undetermined significance (ASCUS/HPV), and 11(4%) SILs (low and high-grade). High-grade SILs were identified in 2(0.7%) and no cervical cancer cases were detected. HPV-DNA was detected in 133(47%); 63(56%) in HIV-positives and 70(53%) in HIV-negatives. HPV infection was more frequent in HIV-positives (OR=1.87;95% CI:1.16-3.03). Genotype 16(12%) was the most common, followed respectively by 6(11%), 33(9%), 31(8%), 35(7%), 18(5%), and 11(5%). High-risk genotypes (16,18) of HPV were present in 72% of HIV-positive women and in 50% of HIV-negative women(p=0.012). Regarding low-risk HPV genotypes (6, 11), they were found in 28% of HIV-positive women and in 50% of HIV-negative women(p=0.034).
Conclusions: We report a high prevalence of HPV in women attending an STI clinic with high-risk genotypes more prevalent in HIV-positive women. Sensitive detection methods may have important impact for the management of immunocompromised patients.
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