Incidence of Cervical Squamous Intraepithelial Lesions in HIV-Infected Women

This study was conducted to investigate the elevated incidence of squamous intraepithelial lesions (SIL) of the cervix among women infected with human immunodeficiency virus (HIV). Three hundred twenty-eight women with HIV, recruited from HIV/AIDS clinics, were followed over a 2.5-year period and compared with 325 similar but noninfected women, recruited from a methadone treatment program or sexually transmitted disease clinic. All subjects underwent an initial clinical examination that included an interview, cervical smear, cervicovaginal lavage for human papillomavirus (HPV) DNA testing, cervicography, and colposcopy with biopsy of suspicious areas. The examination was repeated every 6 months; cervical biopsies were performed if indicated.The two study groups had similar clinical and demographic characteristics, except that the HIV-infected women were significantly more likely to have a history of prostitution, intravenous drug use, genital herpes, or genital warts than noninfected women (P < .05). The 328 HIV-infected patients had a mean CD4 cell count of 429 × 10/liter at the initial clinical examination. More than half of them (178 of 328, 54 percent) took one or more antiretroviral medications for at least 6 consecutive months during the study.At the initial clinical examination, HPV DNA was found in 143 of the 264 women (54 percent) with HIV whose HPV testing was adequate for analysis and in 85 of the 265 noninfected women (32 percent) with adequate HPV testing. HPV DNA was detected at two or more visits in 61 percent of HIV-infected women (155 of 256) and in 23 percent of noninfected women (58 of 257) who returned for at least two follow-up visits over a 3- to 12-month period. This difference in the percentages of women with persistent HPV infection is significant (P < .001).Over the course of the study, 67 of the 328 women (20 percent) with HIV infection developed SILs, compared with 16 of the 325 non-HIV infected women (5 percent). This difference is significant (P < .001). More than 90 percent (61 of 67, 91 percent) of the lesions among the women in the HIV group and 75 percent (12 of 16) of the lesions in the non-HIV group were low-grade SIL. No women developed invasive carcinoma of the cervix during the study.For the subjects who had 54 months of follow-up, the presence of HPV DNA infection on the cervix at the initial examination was found to be a significant predictor of the development of SILs (P < .001). After 54 months, 48 percent of the