Short-term follow up of cervical squamous intraepithelial lesions associated with HIV and human papillomavirus infections in Africa

Int J STD AIDS. 1999 Jun;10(6):363-8. doi: 10.1258/0956462991914276.

Abstract

A prospective study in gynaecology clinics was conducted in Abidjan, Côte d'Ivoire, to assess the short-term evolution of squamous intraepithelial lesions (SILs). Of 94 women with a cytological diagnosis of SIL, 38 were infected with HIV. The average follow-up period after the initial smear was 5 months. Detection of human papillomavirus (HPV) by polymerase chain reaction (PCR) was performed at both the time of enrolment and final follow-up smear. There were 39 cases of persistent SILs. HIV-positive women had a higher percentage of persistent SIL (76%) than HIV-negative women (18%, relative risk (RR)=4.3, 95% confidence interval (CI) = 2.4, 7.7). SILs were more frequent among women infected with HPV at the time of enrolment or with persistent HPV infection, but these associations disappeared after adjusting for HIV serostatus. Spontaneous regression of SILs commonly occurs in HIV-negative African women. HIV-infected women with cervical dyskaryosis require gynaecology follow-up.

PIP: A prospective study was conducted in a gynecology clinic in Abidjan, Cote d'Ivoire, to assess the short-term evolution of cervical squamous intraepithelial lesions (SIL) associated with HIV and human papillomavirus (HPV) infections. Final analysis included 94 women with cytological diagnosis of SIL, who were seen for initial and follow-up smear control. All women underwent HIV antibody testing after pre-test counseling upon recruitment, and polymerase chain reaction was performed to detect HPV. Out of the 94 women, 38 were infected with HIV and 39 had persistent cases of SIL. HIV-positive women had a higher percentage of persistent SIL (76%) than those who were HIV-negative. SIL incidence was more frequent among women infected with HPV at the time of enrollment or with persistent HPV infection. This study concludes that if HPV infection plays a major role in cervical SIL, other factors contribute to the progression or regression of the lesion, particularly HIV-induced immunosuppression. Therefore, HIV screening should be offered to women with SIL, and specific gynecology follow-up should be conducted on HIV-infected women with cervical SIL in Africa.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Africa
  • Carcinoma, Squamous Cell / complications*
  • Carcinoma, Squamous Cell / physiopathology
  • Cervical Intraepithelial Neoplasia / complications*
  • Cervical Intraepithelial Neoplasia / physiopathology
  • Cote d'Ivoire
  • Female
  • Follow-Up Studies
  • HIV Infections / complications*
  • Humans
  • Middle Aged
  • Papillomaviridae* / classification
  • Papillomaviridae* / genetics
  • Papillomavirus Infections / complications*
  • Papillomavirus Infections / virology
  • Prospective Studies
  • Time Factors
  • Tumor Virus Infections / complications*
  • Tumor Virus Infections / virology
  • Uterine Cervical Neoplasms / complications*
  • Uterine Cervical Neoplasms / physiopathology