Modifiable and non-modifiable factors related to HPV infection and cervical abnormalities in women at high risk: a cross-sectional analysis from the Valhidate Study

Abstract: Migrant women, and women infected with HIV, are at enhanced risk of cervical HPV infection and HPV-related cancers. We investigated factors that can reduce these risks through public health preventive and screening interventions. We compared prevalence and risk factors for cervical HPV infection/lesions in women with HIV-infection (HIW) and migrant women (RMW) with a control group of resident women (SPW) who were enrolled in the study for the eVALuation and monitoring of HPV Infections and relATEd cervical diseases in high-risk women (VALHIDATE). Among 3093 evaluable women, age-standardized HPV prevalence was 36.3% (95%CI: 28.1\u201344.4) in HIW, 21.6% (95%CI: 15.7\u201327.5) in RMW, and 14.3% (95%CI: 12.5\u201316.1) in SPW. Adjusted prevalence of HPV infection was 2.07 times higher among HIW (95%CI: 1.75\u20132.45), and 1.45 times higher among RMW (95%CI: 1.17\u20131.80) than in SPW. Prevalence-ratios of SIL and HG-SIL were 2.67 (95%CI: 2.06\u20133.45) and 2.82 (95%CI: 1.28\u20136.20), respectively, in HIW compared to controls. A multivariate log-binomial regression model showed modifiable risk factors associated with HPV infection/lesion to have different patterns among groups. Specific public-health intervention, including health and sexual-health education, safe-sex procedures, and improvements to screening programmes, could favorably affect these highly vulnerable women

Electrical stimulation with non-implanted electrodes for overactive bladder in adults

Peer reviewedPublisher PD

Vulvar neoplasia in HIV positive women : a review

Among genital malignancies, vulvar cancer and its precursor, Vulvar Intraepithelial Neoplasia (VIN), is less commonly encountered than cervical neoplasia. According to R.W. Jones (2001) vulvar cancer represents about 3-5% of all genital neoplasms and its peak of incidence is between 60 and 80 years of age. Risk factors for vulvar carcinoma are: smoking and immune depression, which expose to a higher risk of vulvar HPV infection caused by high risk strains. In recent years, increased prevalence and incidence of high grade VIN and vulvar invasive carcinoma in young patients (below 45 years of age) have been reported. The main group of affected cases is represented by HIV infected women. Data about the severity of immune depression, expressed by CD4 cell count, as an adjunctive risk factor for persistence, recurrence or progression, are conflicting and scanty. Moreover, information about the effect of Highly Active Antiretroviral Therapy (HAART) on the natural history of VIN are inconclusive. So far, a thorough examination of the vulvar region, associated with colposcopy and biopsy when indicated, should be considered a routine procedure in the gynaecological surveillance of HIV positive women

Mucosal immune response to Human Papilloma Virus (HPV) infection in HIV positive women

Mucosal immunity plays a central role in the control of genital human papilloma virus (HPV) infection. HIV infection is associated with higher risks of HPV-induced neoplasias. Prevalence, incidence and evolution of genital HPV lesions are correlated with the level of immunodepression. Several changes of the local immune response in the genital tract of HIV infected women have been demonstrated. The influence of HIV on the production of some immunoregulatory cytokines appears of particular interest. The shift from the helper T cells type 1 (Th1) to the helper T cells type 2 (Th2) immune response, which determines the downregulation of the cell-mediated immunity, may explain the frequent loss of immunologic control of HPV and its oncological complications

Polycarbophil vaginal moisturizing gel versus hyaluronic acid gel in women affected by vaginal dryness in late menopausal transition: A prospective randomized trial

Objectives: During menopausal transition, women are frequently affected by vulvovaginal atrophy (VVA), due to the decline of estrogen levels. Resulting symptoms are itching, burning, dyspareunia, and vaginal dryness (reported in up to 85%). The aim of this trial was to verify if medical device polycarbophil vaginal (PCV) moisturizer gel is not less effective than hyaluronic acid (HA) gel in treating vaginal dryness. Material and methods: This was a multicenter, open label, randomized, parallel group, comparative study with non-inferiority design. Female included were ≥45 to ≤55 years in the menopausal transition, with subjective dryness, any objective sign of VVA, pH > 5, and body mass index of ≥18.5 to ≤36 kg/m2. Subjects were randomized to 1 g of PCV gel twice a week for 30 days or 3 g of HA vaginal gel every 3 days for 30 days. Results: 53 subjects (mean age 49.45 ± 2.96 years) were analyzed. Vaginal health index showed an improvement (p < 0.001) in both groups (from 12.54 ± 1.37 to 16.36 ± 2.66 for PCV, from 12.00 ± 1.91 to 16.60 ± 2.50 for HA), but the difference between final means (95%CI: −1.66 to 1.18) evidenced that PCV is non-inferior to HA treatment. Similarly, an improvement was evidenced in vaginal maturation index (p = 0.005 for PCV, ns. for HA), female sexual function index (p < 0.001 for PCV, p < 0.001 for HA), and SF-12 (p < 0.001 for PCV, p < 0.001 for HA), with no difference between groups. Safety was optimal and no adverse events were reported. Conclusions: The use of HA gel does not give additional benefits to those that are already provided by the moisturizing PCV

HPV, HIV infection, and risk of cervical intraepithelial neoplasia in former intravenous drug abusers

The relation between human immunodeficiency virus (HIV), human papilloma virus (HPV) infection, sexual habits, reproductive history, and risk of cervical intraepithelial neoplasia (CIN) has been analyzed in a cross-sectional study conducted since 1986 among female former intravenous drug abusers attending for the first time to the Colposcopic Unit of the Ospedale Luigi Sacco of Milan and women consecutively admitted to the Community for Past Drug Abusers, S. Patrignano, Rimini. A total of 434 subjects entered the study; of those 128 (30%) had a diagnosis of CIN. Compared with HIV-negative subjects, odds ratio (OR) of CIN was 8.0 (95% confidence interval (CI) 4.6-14.1) for HIV-positive ones and the frequency of CIN 2 and 3 was higher in HIV-positive than that in HIV-negative subjects (chi 2(1), trend, 6.67, P 0.01). Compared with women without current HPV infection the OR estimate was 38.0 (95% CI 20.3-71.2) in those with current diagnosis of HPV infection. Considering HIV-positive subjects only, the frequency of CIN increased with stage of HIV infection and was higher in women with lower CD4+ values. Finally, no relation emerged between CIN risk and age, indicators of sexual habits, oral contraceptive use, parity, and history of spontaneous or induced abortions