Is HIV infection a cofactor for cervical squamous cell neoplasia?

The objective of this study was to test the hypothesis that HIV interacts w ith human papilloma virus (HPV) to increase the odds of cervical neoplasia, The study design was a meta-analysis using data pooled from published sourc es. Studies published between January 1986 and March 1998 were eligible for inclusion if they included data on neoplasia (cytology-based), HIV (define d by laboratory and/or standard clinical criteria), and HPV (assessed by PC R, Southern blot, dot-blot hybridization, or cytology of an otherwise well designed study) among nonpregnant women. Blinded data abstraction was perfo rmed independently by the investigators. There were 15 studies that were eligible and presented data in a format tha t could be abstracted for analysis. Data were pooled using a Mantel-Haensze l summary odds ratio (OR); generalized estimation regression equations were used to examine independent effects of HIV and DPV, Overall, based on the Mantel-Haenszel ORs, there was a strong overall association between HPV and neoplasia [OR, 8.1; 95% confidence interval (CI), 6.5-10.1]. Stratifying b y HIV status, HIV-positive women had higher odds of disease (OR, 8.8; 95% C I, 6.3-12.5) than HIV-negative women (OR, 5.0; 95% CI, 3.7- 6.8). In the re gression model, there was an interaction between HPV and HIV (P = 0.01); im munosuppression also tended to predict neoplasia (P = 0.058). HIV seems to be a cofactor in the association between HPV and cervial neopl asia; this effect may vary by level of immune function. These speculations are biologically plausible, Additional data from large, well designed studi es are needed to confirm these hypotheses.