CD4 T-cell count, viral load, and squamous intraepithelial lesions in women infected with the human immunodeficiency virus

BACKGROUND. Recent studies have reported an increased incidence of squamous intraepithelial lesions in women infected with the human immunodeficiency virus (HIV). However, to the authors' knowledge there are scarce data regar ding the relation between the CD4 T-lymphocyte count (CD4+), HIV. viral loa d, and the development of cervical dysplasia as evidenced by cervicovaginal cytology. The objective of the current study was to examine the associatio n between cervicovaginal smears (with and without squamous lesions) from HI V-infected women and their CD4+ counts and HIV viral load. METHODS. Two hundred ninety-six cervicovaginal smears from 108 HIV-infected women were reviewed and classified according to the Bethesda system. Abnor mal cytologies (n = 74) were followed by colposcopy and/or biopsy. CD4+ cou nts and HIV viral loads were available at the time of the cytologic evaluat ion. Statistical analysis was performed using the Student t rest and the Ma nn-Whitney U test. RESULTS, The control group (n = 222) had significantly higher CD4+ counts ( 378 vs. 246 cells/muL: P < 0.001) compared with the group with cervical les ions. There was no apparent difference between the CD4+ counts from women w ith low grade lesions and those from women with high grade lesions. The HIV viral load was significantly higher in patients with cytologic abnormaliti es than in those with negative Papanicolaou smears (P = 0.006). CONCLUSIONS, The degree of immunosuppression may contribute to the developm ent of intraepithelial lesions in HIV-positive women, but once the lesion i s established disease progression may not be affected by the CD4+ counts. C ancer (Cancer Cytopathol) 2001;93:111-114, (C) 2001 American Cancer Society .