The natural history of Human Papillomavirus (HPV) in Human Immunodeficiency Virus (HIV)-infected individuals differs from that of immune competent hosts. Specifically, spontaneous rate of clearance of HPV may be affected by presence of HIV-coinfection and the degree of HIV-related immunosuppression. We conducted a retrospective chart review of cervico-vaginal and anal Papanicolaou smear (Pap) results and clinical correlates in a population of HIV-infected women followed in our inner city medical center.
Records of 185 HIV-infected women were available for review. Of those, 167 were behaviorally infected (BI) and 18 acquired their HIV through perinatal transmission (PT). Demographic, immunologic and virologic parameters at the time of the Pap were recorded. Abnormal Pap included low and high grade squamous intraepithelial lesions and ASCUS. Colposcopic and high resolution anoscopy (HRA) results and patient outcomes were documented. HPV typing was available for some but not all samples.
The median age of the cohort was 40 years (16-62 years). In the PT cohort there were 11 anal and 12 vaginal abnormal Pap. In the BH women cohort there were 143 anal and 124 vaginal abnormal Pap. Among the patients with abnormal Pap results, 55 had abnormal findings that were persistent. All but 4 of those 55 patients underwent colposcopy and/or HRA. 18 of the 55 patients required further ablative and/or colorectal corrective surgery. Severity of disease and need for surgery correlated with degree of immune suppression and worse virologic control. Age and mode of HIV transmission was not found to be a correlate of severity.
High degree of HPV disease severity was found in a cohort of women who were both behaviorally and perinatally HIV-infected. This points to the need for aggressive preventive screening and treatment strategies.
M. Hennessy, None
M. Rosenberg, None
J. Sansary, None
J. Abadi, None
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