Incidence of HPV infection in the uterine cervix in HIV positive pregnant women seen at the Hospital de Base in São José do Rio Preto, Brazil

Objective: To evaluate the incidence of HPV-HIV co-infection among pregnant women and to relate it to CD4+ cell count in peripheral blood, to the  expression of protein p16 in the epithelium of the uterine cervix and  to the presence of HPV DNA in cervical biopsies. Methods: Pregnant women at the same age were selected and distributed into two groups with 70 patients  each: HIV positive (Study Group) and HIV negative (Control I). Another group (Control II) comprised 36 HIV negative patients at different ages and with the diagnosis of cervical intraepithelial neoplasia, in the period from 2000 to 2007. Colpocytology and/or cervical biopsy of these patients were analyzed for the occurrence of morphological characteristics, suggesting HPV infection; for the CD4 count in peripheral blood; and expression of protein p16 in the cervix epithelium and compared the findings with p16 expression in a group of 36 women with cervical epithelial neoplasm. PCR was performed in the samples of the Study Group to confirm the presence of HPV DNA. Rresults: The 70 HIV positive pregnant patients were aged from 15 to 45 years (mean of  28 years, median of 28.2 years). Twenty-two (31.4%) of them presented morphological changes consistent with cervical HPV infection; of these, 16 presented CD4 count lower than 500 cells (p=0.03). In the  HIV negative  Group, one  patient (1.4%) had cervical intraepithelial lesion. Ten cervical biopsies  in the Study  Group presented HPV DNA in the PCR. The Control Group II showed similar results to the Study Group. Cconclusions: The incidence of HPV-HIV co-infection in pregnant women was relevant compared to  the HIV negative Group. In the HIV-positive Group, the incidence of HPV was directly related to low immunity. The p16 expression was stronger among the cases diagnosed as having higher grade intraepithelial cervical lesions (CIN 2 and 3). The presence of HPV DNA was confirmed through PCR in cervical lesions of HIV positive pregnant women. This study points to the importance of having periodic gynecological exams and routine cytology screening tests for the early detection of HPV infection during antenatal care of HIV-positive pregnant women