[Squamous intra-epithelial lesions in HIV seropositive females. Their frequency and association with cervical neoplasia risk factors].

OBJECTIVE: Determining the prevalence of squamous intraepithelial lesions (SIL), and their association with known cervical neoplasia risk factors in seropositive HIV female patients.

MATERIALS AND METHODS: A transversal study including 50 seropositive HIV female patients was carried out. The patients were interrogated concerning known cervical neoplasia risk factors. Cervical cytology tests and colposcopic evaluations of the lower genital tract, with directed biopsies, were carried out. The presence of HPV-DNA was investigated using the polymerase chain reaction and CD4 and CD8 T lymphocyte titers were determined. Two comparison groups were formed, in accordance to the presence or absence of cervical lesions.

RESULTS: Average age was 36 +/- 9.3 years, ranging from 20 to 61 years, 26% had never submitted to a cervical cytology test, and an average of 33 months (1-130 months) had elapsed after the last test of those who had. HIV transmission had been sexual in 72% of the cases, and the period of time elapsed since the infection was diagnosed and until the patients were evaluated for this study was of 40.6 +/- 33.5 months. HPV-DNA was detected in 64% (n = 32) of the patients, and co-infection with more than one HPV was detected in 42% of them, with the 16 and 31 types being the most frequent. A cervical lesion was diagnosed in 52% of the cases, 18% being of high degree and 34% of low degree. When risk factors for cervical neoplasia and lymphocyte titers were compared between group I (with SIL, n = 26), and group II (without SIL, n = 24), the only significant differences found were the presence of HPV-DNA and the co-infection with more than one type of HPV, which were more frequent in group I. Sexual transmission of HIV was also more frequent in group I. The presence of vaginal and vulvar synchronous lesions was determined in 20% and 12% of the cases, respectively.

CONCLUSIONS: There is a high prevalence of positive DNA-HPV and SIL in seropositive HIV patients, which pose them in a higher risk of developing invasive cervical cancer. Thus, creating adequate strategies for the detection, diagnosis, management, and follow-up of these patients is of the utmost importance.