Angela Cristina Labanca de Araújo

Cervical intraepithelial neoplasia recurrence after conization in HIV-positive and HIV-negative women

To evaluate the recurrence rates of cervical intraepithelial neoplasia (CIN) in a cohort of HIV‐infected and noninfected women who underwent the loop electrosurgical excision procedure (LEEP).

Prevalence and Risk Factors Associated With Anal Intraepithelial Neoplasia Among HIV-Positive Men in Brazil

Objective This study aimed to assess the prevalence of, and associated factors with, anal intraepithelial neoplasia (AIN) among HIV-positive men evaluated at public health services in Brazil. Materials and Methods This is a multicenter cross-sectional study of HIV-positive male patients attending 6 public AIDS referral clinics in urban Brazil. Participants were interviewed for sociodemographic and behavioral characteristics. Anal swab specimens were collected for anal cytology and HPV DNA testing using L1 polymerase chain reaction. Univariate and multivariate analyses were performed to evaluate risk factors associated with the presence of low-grade squamous intraepithelial lesion (LSIL) and/or high-grade squamous intraepithelial lesion (HSIL). Results Anal swabs were collected from 343 participants. Prevalence of LSIL/HSIL was 24.8%. The majority (60.1%) reported sexual intercourse with both men and women in their lifetime. At least 36.7% had 1 or more oncogenic HPV types. Four variables were independently associated with the presence of LSIL/HSIL in multivariate analysis: history of sex with both men and women (odds ratio [OR] = 4.8) or men only (OR = 6.2) compared with those having sex with women only; current cigarette smoking (OR = 2.2); current CD4+ level between 200 and 500 cells/mm3 (OR = 2.9) or below 200 cells/mm3 (OR = 3.8) compared with CD4+ level above 500 cells/mm3; and presence of oncogenic anal HPV infection (OR = 9.6). Conclusions We found a high prevalence of AIN among HIV-positive men in Brazil. This population may serve as an important bridge population to women with implications for anogenital HPV infection in both men and women. Our findings confirm the need to assess screening programs for AIN among high-risk groups, similar to those used to prevent cervical cancer.

Prevalence and risk factors for cervical intraepithelial neoplasia among HIV-infected women.

OBJECTIVES To evaluate the prevalence and the risk factors for cervical intraepithelial neoplasia (CIN) among HIV-infected women. METHODS Cross-sectional study of 494 HIV-infected women in Brazil, between 1998 and 2008. Gynecologic exam was performed, and samples were collected for cervical cytology and for HPV DNA detection. Cervical biopsy was carried out when indicated. HPV infection, CD4 T-lymphocyte count and HIV viral load were compared with cervical histopathology. Univariate and multivariate statistical analyses were performed to evaluate the statistical association of several risk factors. RESULTS CIN prevalence detected by histopathology was 23.4% (6% of CIN2/3 and 17.4% cases of CIN1). Multivariate analysis confirmed an independent association of CIN with CD4 T-lymphocyte count below 200 cells/mm³ (OR 5.0, 95% CI 2.5-10.1), with a positive detection of HPV DNA (OR 2.0, 95% CI 1.2-3.5), and with age < 34 years old (OR 1.5, 95% CI 1.0-2.4). HIV viral load and antiretroviral use were not independent risk factors for CIN. CONCLUSIONS Severity of immunosuppression, presence of HPV infection and younger age are strong predictors of CIN among HIV-infected women.

Prevalence and multiplicity of HPV in HIV women in Minas Gerais, Brazil

OBJECTIVE To detect the frequency and subtypes of HPV in the uterine cervix of HIV-infected women. METHODS Sample consisted of 288 HIV-infected women, recruited from the public health system of five cities of Minas Gerais, Brazil. Women were seen from August 2003 to August 2008. Cervical samples were collected for cytological analysis and for HPV DNA detection, using polymerase chain reaction (PCR). HPV DNA was classified according to its oncogenic potential in low risk (types 6, 11) and high risk (types 16, 18, 31, 33, 35). Colposcopy was performed, followed by cervical biopsy when necessary. Categorical variables were compared using the Chi-squared test, with a significance level established at the 5% level. RESULTS HPV prevalence was 78.8%. Most frequent genotypes were HPV-6 (63.9%) and HPV-16 (48.5%). High-risk HPV were observed in 70.5% of the women; low-risk in 71.4%; both high and low-risk HPV were detected in 55.1% of the patients. Multiple HPV genotypes were detected in 64.8% of the patients; two genotypes in 23.8%, and three in 18.9%. CONCLUSION HPV prevalence was high among HIV-infected women. Multiple HPV genotypes were common in samples from the uterine cervix of HIV-infected women.

Incidence of cervical intraepithelial neoplasia in a cohort of HIV-infected women

To assess cervical intraepithelial neoplasia (CIN) incidence in HIV‐positive women and the risk factors for these lesions.

Problemas ginecológicos mais freqüentes em mulheres soropositivas para o HIV

PURPOSE: to present the most frequent gynecologic results in a cohort of 300 outpatient HIV-infected women. METHODS: this is a prospective and descriptive study of HIV-infected women that have been followed up at the gynecological clinic from November 1996 to December 2002. These patients were subjected to a specific protocol which included an interview, a gynecological evaluation and a collecting cervical sample for Pap smear, research of HPV (PCR) and colposcopy. Cervical biopsy was performed when necessary. Data were stored and analyzed by Epi-Info, version 6.0. RESULTS: the mean age was 34.5 years. The small number of sexual partners, average of three partners, and the predominance of heterosexual contagion should be mentioned: 271 (90.6%) patients were contaminated through sexual contact with their partners. There was a high prevalence of cervical intraepithelial neoplasia (CIN) representing 21.7% of the total group. Of 109 patients subjected to PCR, 89 (81.7%) were found to have some HPV genotype. An inflammatory smear was present in 69% of the patients. CONCLUSIONS: there is a high frequency of CIN and genital infectious diseases among HIV-infected women, mainly HPV.

Acuidade da citologia oncótica para o diagnóstico da infecção pelo HPV no colo uterino de mulheres portadoras do HIV

PURPOSE to verify the accuracy of uterine cervix cytology for HPV diagnosis, as compared to polymerase chain reaction (PCR) in samples of women with HIV. METHODS 158 patients who had undergone a first collection of material from the uterine cervix with Ayres spatula for PCR were included in the study. Then, another collection with Ayres spatula and brush for oncotic cytology was performed. Only 109 slides were reviewed, as 49 of them had already been destructed for have being filed for over two years. RESULTS the prevalence of HPV was 11% in the cytological exam and 69.7% in the PCR. Age varied from 20 to 61 years old, median 35 years. The HIV contagious route was heterosexual in 91.8% of the cases, and 79.1% of the patients had had from one to five sexual partners along their lives. The most frequent complaint was pelvic mass (5.1%), and 75.3% of the women had looked for the service for a routine medical appointment. The categorical variable comparison was done through contingency tables, using the chi2 test with Yatess correction to compare the ratios. The Fishers test was used when one of the expected rates was lower than five. In the comparison of diagnostic tests, sensitivity, specificity and similarity ratios have been calculated. Among the 76 patients with HPV, detected by PCR, only 12 had the diagnosis confirmed by cytology (sensitivity=15.8%), which on the other hand did not present any false-positive results (specificity=100%). Concerning the HPV presence, the cytological prediction for positive results was 100% and 33.3% for negative, when both results were compared. Among the 12 patients with HPV positive cytology, four (33.3%) presented cervical intraepithelial neoplasia (OR=56; positive similarity ratio=positive infinity; negative similarity ratio=0.83). CONCLUSIONS As the cytology specificity is quite high, it is possible to rely on the positive result, which means that a positive result will surely indicate the presence of HPV. The low sensitivity of cytology does not qualify it as a survey exam for HPV detection in this female group.

Associação entre a carga viral e os linfócitos T CD4+ com as lesões intra-epiteliais do colo uterino em mulheres infectadas pelo vírus da imunodeficiência humana

OBJETIVOS: verificar se a contagem de linfocitos T CD4+ e a carga viral do HIV tem influencia na presenca de lesoes intra-epiteliais cervicais (SIL). METODOS: estudo transversal, no qual foram selecionadas 134 mulheres HIV-positivas, todas submetidas a biopsia do colo uterino, quantificacao da carga viral do HIV e contagem de linfocitos T CD4+. Os valores laboratoriais da quantificacao da carga viral e da contagem de linfocitos T CD4+ foram obtidos antes da realizacao da biopsia, tendo sido estabelecidos cortes para o estudo da carga viral ( 50.000 copias/mL) e contagem de linfocitos T CD4+ ( 350 celulas/mm3). Foram realizados os testes c2, c2 de tendencia linear, c2 de Mantel-Haenszel e analise de variância. Estabeleceu-se significância estatistica para p<0,05 e intervalo de confianca a 95%. RESULTADOS: nao houve tendencia de risco para as mulheres HIV-positivas apresentarem SIL com o aumento da carga viral ou diminuicao dos linfocitos T CD4+. Comparando-se a carga viral com a presenca ou ausencia de SIL, estratificada pelo tempo em que foi quantificada, houve diferenca significante para valores acima de 400 copias/mL (OR: 3,17; IC 95%: 1,02-9,93; p=0,048). Nenhuma associacao foi encontrada para a contagem de linfocitos T CD4+ com a presenca da SIL. CONCLUSAO: as pacientes com carga viral do HIV maior que 400 copias/mL, quantificada antes da biopsia do colo uterino, apresentaram chance 3,17 vezes maior de desencadear SIL. A contagem de linfocitos T CD4+ nao influenciou no aparecimento da SIL.