Infectious Diseases

BRAZ J INFECT DIS. 2012;16(2):164-169

INFECTIOUS DISEASES
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The Brazilian Journal of

Original Article

Prevalence and risk factors for cervical intraepithelial neoplasia among HIV-infected women
Nara Chartuni Pereira Teixeiraa, Angela Cristina Labanca Araújoa, Christine Miranda Correab, Claudia Teixeira da Costa Lodic, Maria Inês Miranda Limaa, Nara deOliveira Carvalhod, Dora Mendez del Castillod, Victor Hugo Meloe*
aDepartment bDepartment

of Health Services, Belo Horizonte, MG, Brazil of Health Services, Três Rios, MG, Brazil cFaculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil dCenter for Research and Diagnosis (NUPAD), School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil eSchool ofMedicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil

ARTICLE INFO

A B S T R A C T

Article history: Received 7 October 2011 Accepted 11 December 2011 Keywords: HIV DNA probes, HPV Cervical intraepithelial neoplasia Immunosuppression

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 wereperformed 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 immunosupression, presence of HPV infection and younger age are strong predictors of CIN among HIV-infected women. © 2012 Elsevier Editora Ltda. All rights reserved.

Introduction
HIV infection has become a burden on the female population. In developing countriesduring the past decade, the HIV/AIDS pandemic has overloaded the health care system

with an enormous impact on women, particularly those of reproductive age.1 In Brazil, although men still account for the majority of infections, women represent an increasing share of the epidemic, with the male-to-female ratio of AIDS cases decreasing from 15:1 in 1986 to 1.5:1 in 2010.2

*Correspondingauthor at: School of Medicine, Universidade Federal de Minas Gerais, Av. Alfredo Balena 190/2nd floor, Belo Horizonte, MG , 30130-100, Brazil E-mail address: victormelo@terra.com.br (Victor Hugo Melo) 1413-8670/© 2012 Elsevier Editora Ltda. All rights reserved.

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Human papillomavirus (HPV) infection, another viral outbreak of epidemic proportions, isalso a sexually transmitted disease, and has been etiologically linked to both pre-invasive lesions and invasive cervical carcinoma.3 Each year, approximately 490,000 women are newly diagnosed and 274,000 women die from invasive cancer of the uterine cervix induced by oncogenic types of HPV.4 The overwhelming majority of women affected by this completely preventable disease live inresource-constrained nations, where access to screening services is limited or non-existent.5 Several studies have shown that HPV infection is significantly more common among HIV-positive women compared to those that are not infected.6 HIV leads to an increased risk of cervical intraepithelial neoplasia (CIN) and cervical cancer. 7 Up to 20% of these co-infected patients develop HPV-induced premalignant lesions...