6 research outputs found
Factors Associated with Colposcopy-Histopathology Confirmed Cervical Intraepithelial Neoplasia among HIV-Infected Women from Rio De Janeiro, Brazil
Introduction: Despite the availability of preventive strategies (screening tests and vaccines), cervical cancer continues to
impose a significant health burden in low- and medium-resourced countries. HIV-infected women are at increased risk for
infection with human papillomavirus (HPV) and thus development of cervical squamous intraepithelial neoplasia (CIN).
Methods:Study participants included HIV-infected women enrolling the prospective open cohort of Evandro Chagas
Clinical Research Institute, Oswaldo Cruz Foundation (IPEC/FIOCRUZ). At cohort entry, women were subjected to
conventional Papanicolaou test, HPV-DNA test and colposcopy; lesions suspicious for CIN were biopsied. Histopathology
report was based on directed biopsy or on specimens obtained by excision of the transformation zone or cervical
conization. Poisson regression modeling was used to assess factors associated with CIN2+diagnosis.
Results:The median age of the 366 HIV-infected women included in the study was 34 years (interquartile range: 28–41
years). The prevalence of CIN1, CIN2 and CIN3 were 20.0%, 3.5%, and 2.2%, respectively. One woman was found to have
cervical cancer. The prevalence of CIN2+was 6.0%. Factors associated with CIN2+diagnosis in the multivariate model were
age,years compared to350 cells/mm3 (aPR = 6.03 95%CI 1.50–24.3) and concomitant
diagnosis of vulvar and/or vaginal intraepithelial lesion (aPR = 2.68 95%CI 0.99–7.24).
Discussion:Increased survival through wide-spread use of highly active antiretroviral therapy might allow for the
development of cervical cancer. In Brazil, limited cytology screening and gynecological care adds further complexity to the
HIV-HPV co-infection problem. Integrated HIV care and cervical cancer prevention programs are needed for the prevention
of cervical cancer mortality in this group of wome