Screening and treatment for cervical intraepithelial neoplasia (CIN) in HIV-infected women

To determine: 1) whether the pathology correlates with the degree of immunosuppression, 2) whether there is a relation between pathology and antiretroviral therapies, 3) whether Papanicolau (Pap) smears correlate with colposcopic and histologic findings, 4) whether there is rapid genital disease progression after standard gynaecologic care.

Retrospective study. Immunologic, gynaecologic and virologic data were extracted either from patients charts or from laboratory testing.

At first visit Pap smears resulted normal in 43.7% of the women, 8.4% of the patients had reactive and reparative changes, 2.8% atypical cells of undetermined significance, 33.8% low-grade squamous intraepithelial lesions and 11.3% high-grade squamous intraepithelial lesions. Patients with a normal PAP smear had higher CD4 cell count (318+/-191 cells/mL) compared to patients with squamous intraepithelial lesions (297+/-116 cells/mL) but the difference was not statistically significant (Mann-Whitney test). The distribution of cervical dysplasia was found to be similar regardless of antiretroviral therapy (chi(2) test). The sensitivity and specificity of Pap tests for detecting CIN were 94 and 80%. Twenty-two per cent of surgically treated women had persistent or recurrent disease.

Lower CD4+ cell counts are not predictive of the presence of cervical dysplasia. All HIV-infected women, independently from their immunological and clinical conditions, need regular Pap smears with appropriate follow-up for abnormal cervicovaginal cytology, this could prevent nearly all deaths from cervical cancer.