Restricted accessResearch articleFirst published online 2012-1
Cervical cytological abnormalities and factors associated with high-grade squamous intraepithelial lesions among HIV-infected women from Rio de Janeiro,Brazil
Although cervical cancer remains a major public health problem in Brazil, knowledge of cervical cytological abnormalities among HIV-infected women remains scarce. At baseline evaluation of a cohort followed in Rio de Janeiro, Brazil, 703 HIV-infected women underwent cytology-based cervical cancer screening and human papillomavirus (HPV) DNA testing. Poisson regression analysis was used to evaluate the association of factors with the presence of high-grade squamous intraepithelial lesions (HSIL). Cervical cytology was abnormal in 24.3% of the women; 4.1% had HSIL. Beyond HPV infection, factors independently associated with the presence of HSIL was age (≥25 and ≤40 years, prevalence ratio [PR] 2.60, 95% confidence interval [CI] 1.11–6.10), and more than three pregnancies was protective (PR 0.33, 95% CI 0.11–0.94). High coverage of cervical cancer screening is warranted to prevent morbidity and mortality from cervical cancer in this population.
ParkinDM, BrayF. Chapter 2: the burden of HPV-related cancers. Vaccine2006;24(Suppl 3):S11–25
3.
BoschFX, de SanjoseS. The epidemiology of human papillomavirus infection and cervical cancer. Dis Markers2007;23:213–27
4.
BoschFX, LorinczA, MunozN, The causal relation between human papillomavirus and cervical cancer. J Clin Pathol2002;55:244–65
5.
SchiffmanM, CastlePE, JeronimoJ, Human papillomavirus and cervical cancer. Lancet2007;370:890–907
6.
WrightTCJr. Cervical cancer screening in the 21st century: is it time to retire the PAP smear?Clin Obstet Gynecol2007;50:313–23
7.
FrancoEL, Duarte-FrancoE, FerenczyA. Cervical cancer: epidemiology, prevention and the role of human papillomavirus infection. CMAJ2001;164:1017–25
8.
SmithJS, GreenJ, Berrington de GonzalezA, Cervical cancer and use of hormonal contraceptives: a systematic review. Lancet2003;361:1159–67
9.
StricklerHD, BurkRD, FazzariM, Natural history and possible reactivation of human papillomavirus in human immunodeficiency virus-positive women. J Natl Cancer Inst2005;97:577–86
10.
CliffordGM, PoleselJ, RickenbachM, Cancer risk in the Swiss HIV Cohort Study: associations with immunodeficiency, smoking, and highly active antiretroviral therapy. J Natl Cancer Inst2005;97:425–32
11.
PalefskyJM. Cervical human papillomavirus infection and cervical intraepithelial neoplasia in women positive for human immunodeficiency virus in the era of highly active antiretroviral therapy. Curr Opin Oncol2003;15:382–88
12.
HeardI, TassieJM, KazatchkineMD, OrthG. Highly active antiretroviral therapy enhances regression of cervical intraepithelial neoplasia in HIV-seropositive women. AIDS2002;16:1799–802
13.
XiLF, KiviatNB. Cervical neoplasia and highly active antiretroviral therapy. J Natl Cancer Inst2004;96:1051–53
14.
MangclavirajS, KerrSJ, ChaithongwongwatthanaS, Nadir CD4 count and monthly income predict cervical squamous cell abnormalities in HIV-positive women in a resource-limited setting. Int J STD AIDS2008;19:529–32
15.
BollenLJ, ChuachoowongR, KilmarxPH, Human papillomavirus (HPV) detection among human immunodeficiency virus-infected pregnant Thai women: implications for future HPV immunization. Sex Transm Dis2006;33:259–64
16.
FranceschiS, JaffeH. Cervical cancer screening of women living with HIV infection: a must in the era of antiretroviral therapy. Clin Infect Dis2007;45:510–13
Ministry of Health. Cancer Estimates for the Year 2006 in Brazil. Rio de Janeiro, Brazil: National Cancer Institute, 2005
19.
GakidouE, NordhagenS, ObermeyerZ. Coverage of cervical cancer screening in 57 countries: low average levels and large inequalities. PLoS Med2008;5:e132
20.
FonsecaMG, BastosFI. Twenty-five years of the AIDS epidemic in Brazil: principal epidemiological findings, 1980–2005. Cad Saude Publica2007;23(Suppl 3):S333–44
21.
CamposDP, RibeiroSR, GrinsztejnB, Survival of AIDS patients using two case definitions, Rio de Janeiro, Brazil, 1986–2003. AIDS2005;19(Suppl 4):S22–26
22.
GrinsztejnB, VelosoVG, LeviJE, Factors associated with increased prevalence of human papillomavirus infection in a cohort of HIV-infected Brazilian women. Int J Infect Dis2009;13:72–80
23.
CaloreEE, PereiraSM, CavaliereMJ. Progression of cervical lesions in HIV-seropositive women: a cytological study. Diagn Cytopathol2001;24:117–19
24.
GrinsztejnB, BastosFI, VelosoVG, Assessing sexually transmitted infections in a cohort of women living with HIV/AIDS, in Rio de Janeiro, Brazil. Int J STD AIDS2006;17:473–78
25.
SahasrabuddheVV, MwanahamuntuMH, VermundSH, Prevalence and distribution of HPV genotypes among HIV-infected women in Zambia. Br J Cancer2007;96:1480–83
26.
BlossomDB, BeigiRH, FarrellJJ, Human papillomavirus genotypes associated with cervical cytologic abnormalities and HIV infection in Ugandan women. J Med Virol2007;79:758–65
27.
HankinsC, CoutleeF, LapointeN, Prevalence of risk factors associated with human papillomavirus infection in women living with HIV. Canadian Women's HIV Study Group. CMAJ1999;160:185–91
28.
LuqueAE, JabeenM, MessingS, Prevalence of human papillomavirus genotypes and related abnormalities of cervical cytological results among HIV-1-infected women in Rochester, New York. J Infect Dis2006;194:428–34
29.
MassadLS, RiesterKA, AnastosKM, Prevalence and predictors of squamous cell abnormalities in Papanicolaou smears from women infected with HIV-1. Women's Interagency HIV Study Group. J Acquir Immune Defic Syndr1999;21:33–41
30.
NappiL, CarrieroC, BettocchiS, Cervical squamous intraepithelial lesions of low-grade in HIV-infected women: recurrence, persistence, and progression, in treated and untreated women. Eur J Obstet Gynecol Reprod Biol2005;121:226–32
31.
AlmonteM, AlberoG, MolanoM, Risk factors for human papillomavirus exposure and co-factors for cervical cancer in Latin America and the Caribbean. Vaccine2008;26(Suppl 11):L16–36
32.
FonsecaLA, Ramacciotti AdeS, Eluf NetoJ. Mortality trends from uterine cervical cancer in the city of Sao Paulo from 1980 to 1999. Cad Saude Publica2004;20:136–42
33.
KalakunL, BozzettiMC. Evolution of uterine cervical cancer mortality from 1979 to 1998 in the State of Rio Grande do Sul, Brazil. Cad Saude Publica2005;21:299–309
34.
LealMC, GamaSG, CamposMR, Factors associated with perinatal morbidity and mortality in a sample of public and private maternity centers in the City of Rio de Janeiro, 1999–2001. Cad Saude Publica2004;20(Suppl 1):S20–33
35.
RamaC, Roteli-MartinsC, DerchainS, Previous screening for cervical cancer among women with cytological and histological abnormalities. Rev Saude Publica2008;42:411–19
36.
LealMC, GamaSG, FriasP, SzwarcwaldCL. Healthy lifestyles and access to periodic health exams among Brazilian women. Cad Saude Publica2005;21(Suppl):78–88
37.
de AlbuquerqueKM, FriasPG, de AndradeCL, Pap smear coverage and factors associated with non-participation in cervical cancer screening: an analysis of the Cervical Cancer Prevention Program in Pernambuco State, Brazil. Cad Saude Publica2009;25(Suppl 2):S301–09
38.
de SanjoseS, PalefskyJ. Cervical and anal HPV infections in HIV positive women and men. Virus Res2002;89:201–11
39.
AraujoACL, MeloVH, CastroLPF, Association between viral load and CD4+ T lymphocyte count and cervical intraepithelial lesions in HIV-infected women. Revista Brasileira de Ginecologia e Obstetricia2005;27:106–11
40.
ZimmermmannJB, MeloVH, CastroLPF, Association between CD4+ T-cell count and intraepithelial cervical neoplasia diagnosed by histopathology in HIV-infected women. Revista Brasileira de Ginecologia e Obstetricia2006;28:345–51
41.
LehtovirtaP, PaavonenJ, HeikinheimoO. Risk factors, diagnosis and prognosis of cervical intraepithelial neoplasia among HIV-infected women. Int J STD AIDS2008;19:37–41
42.
Ahdieh-GrantL, LiR, LevineAM, Highly active antiretroviral therapy and cervical squamous intraepithelial lesions in human immunodeficiency virus-positive women. J Natl Cancer Inst2004;96:1070–76
43.
ParamsothyP, JamiesonDJ, HeiligCM, The effect of highly active antiretroviral therapy on human papillomavirus clearance and cervical cytology. Obstet Gynecol2009;113:26–31
44.
De BeaudrapP, EtardJF, DioufA, Modeling CD4+ cell count increase over a six-year period in hiv-1-infected patients on highly active antiretroviral therapy in Senegal. Am J Trop Med Hyg2009;80:1047–53
45.
SankaranarayananR, NeneBM, ShastriSS, HPV screening for cervical cancer in rural India. N Engl J Med2009;360:1385–94
46.
RoncoG, SegnanN. HPV testing for primary cervical cancer screening. Lancet2007;370:1740–42
