Comparative study of preinvasive and invasive lesions of the cervix in HIV-positive and HIV-negative women

Background: Evidence suggests that Human Immunodeficiency Virus (HIV) infection is a risk factor for preinvasive and invasive lesions of cervix but confusion regarding pathogenesis and progression of cervical neoplasia in HIV-positive women still prevails. Aims : To find the incidence of cervical neoplasia in HIV positive and HIV-negative women and to study the impact of CD4 counts, duration of HIV infection, and treatment with highly active antiretroviral therapy (HAART) on the incidence of cervical lesions in HIV positive women. Materials and Methods : It was an observational case control study carried over a period of one year at the Department of Obstetrics and Gynaecology and Department of Medicine, King George Medical University, Lucknow. Cases were HIV-positive women and controls were HIV negative women. Those with previous diagnosis or treatment for cervical neoplasia, history of total hysterectomy or coexistent immunosuppressive conditions were excluded. All subjects had cervical screening by Pap smear. Colposcopy and cervical biopsy were done if indicated. Statistical Analysis Used : Chi square test, univariate, and multivariate analysis. Results: The incidence of cervical lesions in HIV-positive women (159.66 per 1000 screened women) was higher compared to HIV-negative women (15.15 per 1000 screened women) (P < 0.001). CD4 counts less than 500/mm ³ were associated with an increased incidence of cervical neoplasia (P < 0.00I). The incidence of cervical lesions in HIV-positive women on HAART was 16.16% as compared to 15% in HIV-positive women not on HAART. Duration of HIV infection more than 2 years was associated with an increased incidence of cervical lesions in univariate analysis (P < 0.001). Conclusions: Seropositivity is associated with an increased incidence of cervical lesions. This risk is further enhanced by CD4 counts less than 500/mm ³ and duration of HIV infection of more than two years.