Risk of high-grade squamous intraepithelial lesion in HIV-infected adolescents

J Infect Dis. 2004 Oct 15;190(8):1413-21. doi: 10.1086/424466. Epub 2004 Sep 13.

Abstract

Background: The risk of developing the human papillomavirus (HPV)-associated precancer high-grade squamous intraepithelial lesion (HSIL) in human immunodeficiency virus (HIV)-infected adolescents is unknown. We examined the risk of developing HSIL among adolescents with and without HIV infection.

Methods: HIV-infected (n = 172) and -uninfected (n = 84) girls aged 13-18 years who were participating in a multicenter study of primarily horizontally acquired HIV infections in adolescents (Reaching for Excellence in Adolescent Health Care) and who did not have HSIL on cytologic examination at study entry or at the first follow-up visit were followed at 6-month intervals. HIV-uninfected girls were recruited for comparison in a 2:1 ratio (HIV infected:HIV uninfected). The primary outcome was cytologic diagnosis of HSIL confirmed by expert review.

Results: Incidence of HSIL by the end of follow-up was higher for HIV-infected girls than for HIV-uninfected girls (21.5% vs. 4.8%, respectively). In multivariate analysis, use of hormonal (either estrogen/progesterone oral combination or medroxyprogesterone acetate intramuscular) contraceptives, high cervical mucous concentrations of interleukin (IL)-12, a positive HPV test, and persistent low-grade squamous intraepithelial lesion (LSIL) were significantly associated with the development of HSIL.

Conclusions: The incidence of HSIL was alarmingly high in HIV-infected adolescent girls. However, when other predictors were considered in multivariate analysis, HIV status was not retained in the model. The heightened risk for HSIL associated with persistent LSIL underscores the need to closely monitor HIV-infected adolescents with LSIL. The risk for HSIL associated with high concentrations of IL-12 may be suggestive of a local immune dysregulation. The role of hormonal contraception as a risk factor deserves further investigation.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Confidence Intervals
  • Female
  • HIV Infections / blood
  • HIV Infections / complications
  • HIV Infections / epidemiology*
  • Humans
  • Incidence
  • Interleukin-12 / blood
  • Multivariate Analysis
  • Neoplasms, Squamous Cell / epidemiology*
  • Neoplasms, Squamous Cell / etiology
  • Papillomavirus Infections / blood
  • Papillomavirus Infections / epidemiology*
  • Papillomavirus Infections / etiology
  • Precancerous Conditions / epidemiology*
  • Precancerous Conditions / etiology
  • Prospective Studies
  • Risk Factors
  • Sexual Behavior
  • United States / epidemiology
  • Uterine Cervical Dysplasia / epidemiology*
  • Uterine Cervical Dysplasia / etiology

Substances

  • Interleukin-12