Cervical dysplasia on cervicovaginal Papanicolaou smear among HIV-1-infected pregnant and nonpregnant women

Objective: To assess the association of squamous intraepithelial lesions (S IL) on cervicovaginal Papanicolaou (Pap) smear among women infected with HI V-1 and their pregnancy status, and historical and clinical factors. Methods: Study enrollment Pap smears of 452 pregnant and 126 nonpregnant HI V-infected women had cytologic evaluation. The rates of SIL were compared w ith pregnancy status, immunosuppression, presence of sexually transmitted d iseases (STDs) and demographic features. Results: Rates of low grade SIL were similar for pregnant and nonpregnant H IV-1-infected women (17% and 23.8%, respectively; p = .09). Of them, 12 wom en, 9 pregnant and 3 nonpregnant, had high grade SIL. None had invasive cer vical cancer. Low CD4 percentage (odds ratio, [OR] = 3.8; 95% confidence in terval [CI], 2.0-7.3) and inflammation(OR = 2.8; 95% CI, 1.8-4.3) were asso ciated with SIL. An association between herpes simplex and SIL (OR = 3.3; 9 5% CI, 1.1-9.5) was less certain due to clinical diagnosis and low prevalen ce of herpes simplex (17 of 456 women). Conclusions: Pap smears far a cohort of HIV-infected pregnant and nonpregna nt women revealed a high prevalence of LGSIL but a low prevalence of HGSIL and no cases of cervical cancer. Although pregnancy may not affect the rate of Pap smear abnormalities, SIL is associated with immunosuppression, cerv ical inflammation, and herpes simplex. Closer surveillance of HIV-1-infecte d women with these risk factors may be warranted.