Cervical Cell Changes in Women Living with HIV in the Northeast of Brazil - Identifying the Target Group for HPV

Background: Human Papillomavirus is the most common sexually transmitted infection among young adult women and acts as main cause of cervical dysplasia and invasive cancer. HIV-infected women are at increased risk of developing HPV-associated dysplasia, aggressive cancer and have more abnormal Pap tests compared with the general population. The objective of the study is to evaluate the frequency of dysplasia and other cervical conditions in a HIV-infected population and compare demographic characteristics of the women with normal and abnormal cytology.

Methods: This is a cross-sectional study. Records of HIV-infected women attended in a reference outpatient clinic for gynecology and prenatal care were evoluated between January and December 2012. Samples for cervical cytology were collected at the moment of the gynecological evaluation, regardless of signs or symptoms. Sociodemographic data and cytology results were obtained from the patients records. Statistical analyses were done using the SPSS 20.0 with IC95%.

Results: In this study, 729 HIV-infected women records were enrolled, the mean age was 38.1 years (SD=10.5). We had 1.4% of unsatisfactory cervical cytology samples. It was founded an overall cellular alterations prevalence of 8.9%, including 3.4% of ASCUS, 0.4% of AGUS, 0,1% of ASC-H, 4.1% LSIL and 0,8% of HSIL. We had no patients with HPV-associate cancer. Association between mean age and the presence of any cellular alteration (p=0,002) and age under 30 years with presence of LSIL (p=0,007) were found.

Conclusions: Prevalence showed to be 6.1 times greater for ASCUS (3.4% versus 0.56%), 2.9 for AGUS (0.4% versus 0.14%), 8.7 for LSIL (4,1% versus 0,47%) and 2.9 for HSIL (0.8% versus 0.28%), when compared with the general population of the state of Bahia (DATASUS,2012). ASC-H prevalence was slightly lower on our group (0.14% versus 0.18%). Knowledge about local characteristics of the HIV-HPV co-infection is important to encourage the promotion of preventive actions and provide early treatment.