Factors associated with colposcopy-histopathology confirmed cervical intraepithelial neoplasia among HIV-infected women from Rio De Janeiro, Brazil

• Published in: PloS one 2011-03, Vol.6 (3), p.e18297-e18297
• Main Authors: de Andrade, Angela Cristina Vasconcelos, Luz, Paula Mendes, Velasque, Luciane, Veloso, Valdiléa Gonçalves, Moreira, Ronaldo I, Russomano, Fabio, Chicarino-Coelho, Janice, Pires, Elaine, Levi, José Eduardo, Grinsztejn, Beatriz, Friedman, Ruth Khalili
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; AIDS vaccines; Analysis; Antiretroviral agents; Antiretroviral drugs; Behavior; Biopsy; Brazil - epidemiology; Cancer; Cancer prevention; Cancer screening; Cancer vaccines; CD4 antigen; Cervical cancer; Cervical Intraepithelial Neoplasia - complications; Cervical Intraepithelial Neoplasia - epidemiology; Cervical Intraepithelial Neoplasia - pathology; Cervical Intraepithelial Neoplasia - virology; Cervix; Colposcopy; Cytology; Demography; Deoxyribonucleic acid; Development and progression; Diagnosis; DNA; Female; Health risks; Highly active antiretroviral therapy; Histochemistry; Histopathology; HIV; HIV infections; HIV Infections - complications; HIV Infections - pathology; HIV patients; Human immunodeficiency virus; Human papillomavirus; Humans; Infection; Infections; Lesions; Lymphocytes T; Medical diagnosis; Medical research; Medicine; Mortality; Poisson density functions; Prevalence; Prevention; Reproducibility of Results; Screening; Smoking; Statistical analysis; T cells; Tobacco; Transformation; Vaccines; Vagina; Vector-borne diseases; Womens health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0018297

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). 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. 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 to ≥ 35 years (aPR  =  3.22 95%CI 1.23-8.39), current tobacco use (aPR  =  3.69 95%CI 1.54-8.78), nadir CD4 T-cell count