CERVICAL INTRAEPITHELIAL NEOPLASIA IN PREGNANT INTRAVENOUS-DRUG-USERSINFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1

Objective: The purpose of this study was to evaluate the frequency and natural history of cervical intraepithelial neoplasia (GIN) during pr egnancy in past or current intravenous drug users infected with human immunodeficiency virus type 1 (HIV-1). Study design: We prospectively evaluated 48 pregnant HIV-1 seropositive patients and 38 HIV seronegat ive controls. All the subjects were current or past intravenous drug u sers. Follow-up visits were carried out each trimester of pregnancy an d 8-12 weeks post-partum with Papanicolau smears, colposcopic examinat ions and,when necessary, colposcopically directed cervical biopsies. R esults: Thirteen of 48 HIV-seropositive women (27.1%) and three of 38 HIV-seronegative controls (7.9%) (P=0.027 by Fisher exact test) had bi opsy-proven CIN at the beginning of pregnancy. High-grade CIN was dete cted in 10 cases (20.8%) and in two (5.3%) controls (P=0.058 by Fisher exact test), None of the cervical squamous intraepithelial lesions pr ogressed throughout pregnancy, in both cases and controls. Post-partum cold-knife cervical conization was performed on seven patients with C IN III and examination of the cone biopsy specimens demonstrated persi stence of CIN III. Conclusions: HIV-infected intravenous drug users ar e at high risk of CIN during pregnancy, thus requiring adequate screen ing programs. Our preliminary data suggest that the progression rate o f CIN during gestation is low in this high-risk group.