Correlation of Cervical Squamous Intraepithelial Lesions with Human Papillomavirus in Women Infected with the Human Immunodeficiency Virus
- 7 Downloads
The human papillomavirus (HPV) is the major etiologic agent in the development of cervical cancer with known risk factors like immunosuppression. The natural history of HPV infection is altered in persons infected with the human immunodeficiency virus (HIV). The persistent HPV infection increases their risk of having cervical squamous intraepithelial lesions (SILs). This study emphasizes on prevalence of high-risk human papillomavirus (HR-HPV) and correlation with cervical smears cytology in HIV-positive women regardless of treatment.
A cross-sectional observational study was conducted at a tertiary care hospital over a period of 2 years. The study group is comprised of HIV seropositive women attending antiretroviral treatment center. CD4 cell counts were taken from the records available, and cervical samples were taken for cytological analysis and HR-HPV testing. Statistical analysis was done using the software Epi 6 Info, and p value was calculated by Chi-square test and Fisher’s exact 2-tailed test for associations of abnormal cytology and to determine risk factors for abnormal cytology.
The median age of the 100 participants was 33.34 years. Low-grade squamous intraepithelial neoplasms (LSILs), high-grade squamous intraepithelial neoplasms, atypical squamous cells of uncertain significance and atypical glandular cells were the precancerous lesions found. Prevalence of HR-HPV in HIV-positive women was found to be 35% among women with abnormal smears. A strong correlation between SILs and HR-HPV with p value of < 0.05 was found. A strong statistical correlation was also seen in between low CD4 count to that of detection of HR-HPV along with LSIL.
A strong correlation between cervical SILs and HR-HPV in our study suggests that routine screening of cervical cytology by PAP smear should include HPV subtype identification in HIV-positive women to pick up cases which are likely to progress to invasive carcinoma.
KeywordsCervical squamous intraepithelial lesions Human papillomavirus Human immunodeficiency virus
GKV conceived the study and was in charge of overall direction and planning and supervised the findings of this work and directed the author and co-authors. GJ wrote the manuscript in consultation with main and co-authors. FAH and VB contributed to case preparation and manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.World Health Organization: Cervical cancer (2018). http://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/. Accessed 10 Nov 2018
- 3.Jan N, Moscicki AB. Human papillomavirus infections in women with HIV disease: prevalence, risk, and management. AIDS. 2000;10:659–68.Google Scholar
- 4.World Health Organization: Human papillomavirus (HPV) and cervical cancer. 2016. https://doi.org/10.1016/j.trsl.2007.03.007.
- 7.Strickler HD, Burk RD, Fazzari M, Nastos K, Minkoff H, Massad LS, Hall C, Bacon M, Levine AM, Watts DH, Silverberg MJ, Xue X, Schlecht NF, Melnick S, Palefsky JM. Natural history and possible reactivation of human papillomavirus in human immunodeficiency virus-positive women. J Natl Cancer Inst. 2005;97:577–86.CrossRefGoogle Scholar
- 8.Wright TC Jr, Ellerbrock TV, Chiasson MA, Van Devanter N, Sun XW. Cervical intraepithelial neoplasia in women infected with human immunodeficiency virus: prevalence, risk factors, and validity of Papanicolaou smears. New York Cervical Disease Study. Obstet Gynecol. 1994;84:591–7.PubMedGoogle Scholar
- 12.Harris TG, Burk RD, Palesky JM, Massad LS, Bang JY, Anastos K, Minkoff H, Hall CB, Bacon MC, Levine AM, Watts H, Silverberg MJ, Xue X, Melick SL, Strickler HD. Incidence of cervical intraepithelial lesions associated with HIV serostatus, CD4 cell counts and human papillomavirus test results. JAMA. 2005;293:1471–6.CrossRefGoogle Scholar
- 24.Peedicayil A, Thiyagarajan K, Gnanamony M, Pulimood SA, Jeyaseelan V, Kannangai R, et al. Prevalence and risk factors for human papillomavirus and cervical intraepithelial neoplasia among HIV positive women at a tertiary level hospital in India. J Low Genit Tract Dis. 2009;13(3):159–64.CrossRefGoogle Scholar
- 28.Human Papillomavirus and Related Diseases Report WORLD.Hpvcentre.net. http://www.hpvcentre.net/statistics/reports/XWX.pdf (2018). Accessed 27 Oct 2018.