HUMAN-PAPILLOMAVIRUS AND HUMAN-IMMUNODEFICIENCY-VIRUS INFECTIONS - RELATION WITH CERVICAL DYSPLASIA-NEOPLASIA IN AFRICAN WOMEN

Our study assessed the factors associated with cervical squamous intra -epithelial lesions (SILs) and invasive cervical cancer, with special attention to human immunodeficiency virus (HIV) and human papillomavir us (HPV) infections, Women from 3 outpatient gynecology clinics of Abi djan, Cote d'Ivoire, were screened for cervical abnormalities: 151 wom en with low-grade SILs and 151 controls, 60 with high-grade SILs and 2 40 controls, and 13 with invasive cancer and 65 controls were enrolled in 3 case-control studies. Controls were chosen at random among the w omen without lesions, with a frequency matching for age and center, We used the PCR method for the detection of cervical HPV DNA and the res triction fragment length polymorphism analysis for HPV typing, HIV ant ibody testing and CD4 cell count were performed. In multivariate analy ses, factors associated with cervical lesions were: for low-grade SILs , HPV positivity, HIV-I seropositivity and parity >3; for high-grade S ILs, HPV positivity, chewing tobacco, HIV-I seropositivity and illiter acy, and for invasive cancer, HPV positivity only. We found a diversit y of HPV types associated with SILs. In HIV-I-infected women, SILs occ urred at an early stage of HIV disease. Women infected with both HIV-I and HPV were at much higher risk of SILs than women infected with eac h of these 2 viruses separately, Invasive cancer was linked to HIV-2 i nfection in univariate analysis only. Our results suggest that the rel ation of SILs with HIV-I infection is mainly explained by HPV infectio n and that HIV-I-infected African women may not often reach the invasi ve stage of cervical cancer. (C) 1998 Wiley-Liss, Inc.