P1-S5.28 Cervical cytology and histopathologic abnormalities in women living with AIDS in SÃo Paulo, Brazil
Authors: Pinto V , Espinosa A , Tancredi M , Golub J , Alencar R 
Published: July 2011

Background

Women living with HIV/AIDS present with a higher prevalence of HPV infection, higher rates of squamous intraepithelial lesions (SIL), and are more susceptible to invasive cervical carcinoma progression.

Objective

We assessed frequency of precursory cervical lesions of cancer and its risk factors for women living with HIV/AIDS.

Methods

Sociodemographic, clinical, behaviour and laboratory data were collected from medical records from 2008 to 2009 and analysed using forward stepwise logistic regression.

Results

Medical records of 631 women were reviewed; mean age at AIDS diagnosis was 34 years old (IQR=29–40 years old), 32% were <16 years old at first sexual intercourse; 61% had ≤5 sexual partners during life; 43% had been living with AIDS for ≥9 years; 47% reported previous sexually transmitted infections; 44% presented with HPV infection and 10% presented with high squamous intraepithelial lesions (HSIL). Presenting HSIL was significantly associated with home district Human Development Index, age at AIDS diagnosis (>40 years old), time of AIDS diagnosis (>8 years), CD4 cell count <350/mm3and HPV infection see Abstract P1-S5.28 Tables 1, 2 & 3.

Abstract P1-S5.28 Table 1

Sociodemographic characteristics of women living with AIDS—São Paulo, Brazil, from 2008 to 2009

CharacteristicsHigh-grade lesionsYes (n=64)No (n=567)Total (n=631)pn%n%n%Age (at AIDS diagnosis)<0.001Up to 40 years old3148.442875.545972.7>40 years old3351.613924.517227.364100.0567100.0631100.0Years of education0.712 None11.661.171.1 1–4 years57.8457.9507.9 5–8 years2742.222639.925340.1 9–11 years2640.621037.023637.4 12 or more46.37513.27912.5 Unknown11.650.961.064100.0567100.0631100.0Race (self-referred)0.005 White3351.636063.539362.3 Black2742.219935.122635.8 Others46.350.991.4Unknown00.030.530.5HDI of home district<0.001 >0.500812.542374.643168.3 0–0.5005687.514425.420031.7Abstract P1-S5.28 Table 2

Behaviour and Clinical Characteristics of women living with AIDS – São Paulo, Brazil, from 2008 to 2009

CharacteristicsHigh-grade lesionsYes (n=64)No (n=567)total (n=631)pn%N%n%Age at first sexual intercourse0.074 Up to 16 years old2742.218031.720732.8 More than 16 years old2843.833258.636057.1 Unknown914.1559.76410.164100.0567100.0631100.0Lifetime number of sexual partners0.058 1 to 2812.513323.514122.3 3 to 52437.521838.424238.4 6 and more2031.310718.912720.1 Unknown1218.810919.212119.264100.0567100.0631100.0STI<0.001 No11.630153.130247.9 Yes6398.423341.129646.9 Unknown––335.8335.264100.0567100.0631100.0HPV cytological changes<0.001 No23.135161.935355.9 Yes6296.921638.127844.164100.0567100.0631100.0(HSV-2)0.969 No5179.745379.950479.9 Yes1320.311420.112720.1Time of AIDS diagnosis<0.001 1 to 8 years1625.034560.836157.2 9 years or more4875.022239.227042.8CD4 Cell counting<0.001 >500 cell/mm311.612622.212720.1 350–500 cell/mm31015.623441.324438.7 <350 cell/mm35382.820736.526041.264100.0567100.0631100.0Abstract P1-S5.28 Table 3

Bi and multivariate analysis of associated factor for high-grade lesion of women living with AIDS – São Paulo, Brazil, 2008 to 2009

Users characteristicsBivariate analysisMultivariate analysisOR (95% CI)pORaj95% CIpHPV cytological changes No1–1– Yes50.4 (12.2 to 208.0)<0.00168.6 (11.6 to 404.6)<0.001CD4 + Cell counting > 500 cell/mm31–1– 350–500 cell/mm35.4 (0.7 to 42.5)0.110.74 (0.1 to 7.3)0.799 < 350 cell/mm332.3 (4.4 to 236.2)0.00124.5 (2.7 to 224.9)0.005HDI of home district >0.5001–1– 0–0.50020.6 (9.6 to 44.2)<0.0013.3 (1.1 to 10.8)0.047Time of HIV diagnosis (years) 1 to 8 years1–1– >8 years4.7 (2.6 to 8.4)<0.0012.9 (1.3 to 6.5)0.012Age level (for AIDS diagnosis) Up to 40 years old1–1– > 40 years old3.3 (1.9 to 5.5)<0.0012.7 (1.2 – 6.0)0.019# Lifetime Sexual partners–– 1 to 21– 3 to 51.8 (0.80 to 4.19)0.153 6 and more3.1 (1.32 to 7.33)0.010STI–– No1– Yes48.8 (6.71 to 354.2)<0.001Race (self-referred) White1––– Black1.5 (0,86 to 2.53)0.153 Others8.7 (2.23 to 34.1)0.002

OR: OR (non adjusted), OR aj: OR adjusted.

Conclusions

Frequent squamous intraepithelial neoplasia in these women shows the importance of gynaecologic exams in routine care and follow-up required by those who present with cervical lesions.