CERVICAL DYSPLASIA AND HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION IN WOMEN - PREVALENCE AND ASSOCIATED FACTORS

Objective: To study the prevalence of Cervical Intraepithelial Neoplas ia (CIN) and its association with HIV-1 infection, controlling for oth er risk factors of GIN. Design: Cross-sectional survey. Subjects and m ethods: HIV-1 seropositive (HIV+) and seronegative (HIV-) women were e nrolled at the Obstetrics-Gynecologic Departments of the Bordeaux Univ ersity Hospital from April 1993 to June 1995, A gynecologic check-up w as performed with a clinical examination, a colposcopy and a Papanicol aou smear. Sexually Transmitted Diseases (STDs) were screened. Colposc opy was interpreted as: normal, low-grade or high-grade lesions. Inter pretation of Papanicolaou smears was based on the 1988 Bethesda system using three descriptive diagnoses: normal, low-grade and high-grade S quamous Intraepithelial lesions (Sns), If colposcopy showed a high gra de lesion or Papanicolaou smear a high-grade SIL, a cervical biopsy wa s performed. Absence of CIN was defined by normal Papanicolaou smear a nd colposcopy. High grade CIN was defined by either identification of high grade SIL on Papanicolaou smear or high grade lesion on colposcop y confirmed by CIN2-3 lesion on biopsy. Other cases were classified as low-grade GIN. HPV infection was diagnosed on presence of koilocytosi s on cytological or histological specimens. Results: Prevalence of CIN was significantly higher in the 128 HIV+ women than in the 102 HIV- w omen: 34.4% vs, 13.7% (O.R.=3.30). Among HIV+ women, 25.8% had low-gra de CIN and 8.6% high-grade CIN versus 10.8% and 2.9%, respectively amo ng the HIV- women. Prevalence of HPV infection was 50.0% among women w ith CIN vs. 5.8% in women without CIN (P=10(-6)). In the multivariate analysis of the determinants of GIN, smoking more than ten pack-years and HPV infection were the only two variables associated with CIN whil e association with HIV infection disappeared. Among HIVS women, the va riables associated with CIN were clinical AIDS and HPV infection. (C) 1998 Elsevier Science Ireland Ltd. Al rights reserved.