Cytological transformation of the cervix in immunodeficiency aggravated by alcoholism

Comorbid pathology, high mortality and disability remain an urgent problem for people with the development of an immunodeficiency state, including women of reproductive age. Prognostic triggers could help to improve management of preneoplastic injury of cervical epithelium.

The aim of this study was to identify the cytological features of the cervical epithelium in women with immunodeficiency status and alcoholism, depending on the level of CD4-lymphocytes.

The study involved cytological analysis of women, who were divided into 3 groups (group consisted of patients with confirmed HIV infection and chronic alcoholism; group consisted of women with chronic alcoholism; comparison group). Determination of CD4 lymphocytes was carried out with gradation of indicators of 500- 350-100 cells per microliter. The relationship between the number of lymphocytes in a smear and changes in epithelial cells was carried out.

Microscopic examination revealed koilocytosis, binuclear and multinuclear cells, keratinocytes, parakeratosis, cytoplasmic amphiphilia in all women of the two studied groups. In addition, epithelial cells were characterized by large size, displacement of the nucleus to the periphery, uneven staining of the cytoplasm, karyopyknosis, karyorrhexis, karyolysis, and dyskeratosis. The inflammatory type of smear was detected in all women of these groups with the presence of neutrophils, eosinophils, lymphocytes, plasmocytes, histiocytes, macrophages and microflora. At the same time, in the comparison group, the inflammatory type of smear was detected only in 36.6%. When studying the relationship between the level of CD4 cells and the degree of damage to the cervical epithelium in the study groups, a strong correlation was established (r=0.824 and r=0.801).

With the development of immunodeficiency status, the number of CD4 cells below 100 per mm3 should be considered as an unfavorable prognostic factor for the development of neoplastic transformation of the cervix.