Human papillomavirus-associated cervical cytologic abnormalities among women with or at risk of infection with human immunodeficiency virus

OBJECTIVE: Correlates of abnormal human immunodeficiency virus cervical cyt ologic findings were examined among women infected with human immunodeficie ncy virus and uninfected women. STUDY DESIGN: We performed a cross-sectional analysis of baseline data on d emographically similar women with infection or risk factors for it. RESULTS: Among 1050 women without hysterectomy, squamous intraepithelial le sions were more common among women infected with human immunodeficiency vir us than among uninfected women (18.8% vs 5.3%; P <.001). In multivariate an alysis the association of squamous intraepithelial lesions with human papil lomavirus infection was strong; adjusted prevalence ratios were 27 for high -risk, 25 for intermediate-risk, and 10 for low-risk types (95% confidence intervals, 12-58, 12-54, and 4-25, respectively). Much lower adjusted preva lence ratios were seen for the only other factor significantly associated w ith squamous intraepithelial lesions, namely, infection with human immunode ficiency virus in conjunction with a reduced CD4(+) cell count. Adjusted pr evalence ratios were 1.9 for CD4(+) cell counts <200 and 1.6 for CD4(+) cel l counts between 200 and 500 (95% confidence intervals, 1.2-3.0 and 1.0-2.5 , respectively). Adjusted attributable fractions calculated for this study population indicated that ii both human immunodeficiency virus and human pa pillomavirus were removed, 47.6% of the observed lesions with atypical squa mous cells of uncertain significance and 93.4% of the observed squamous int raepithelial lesions would be prevented. CONCLUSION: Squamous intraepithelial lesions are more common among human im munodeficiency virus-infected women and are associated most commonly with h igh- and intermediate-risk human papillomavirus types and secondarily with human immunodeficiency virus-associated immune compromise.