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Rev Bras Ginecol Obstet. 2005;27(3):106-111
DOI 10.1590/S0100-72032005000300002
PURPOSE: to evaluate CD4+ T lymphocyte cell count and HIV viral load influence on the presence of cervical squamous intraepithelial lesions (SIL). METHODS: cross-sectional study of 134 HIV-infected women submitted to uterine cervical biopsy, HIV viral load quantification and CD4+ T lymphocyte cell count. Viral load and CD4+ T lymphocyte cell count were performed before biopsy timing. Three different levels of viral load (<400 copies/mL; 401 to 50,000 copies/mL; >50,000 copies/mL) and CD4+ T lymphocyte count (<200 cells/mm³; 200 to 350 cells/mm³; >350 cells/mm³) were defined. Data were statistically analyzed by the chi2 test, linear tendency chi2 test, Mantel-Haenszel test, and analysis of variance, with level of significance set at p<0.05 and 95% confidence interval. RESULTS: there was no risk tendency for HIV-infected women to show SIL with viral load level increase or CD4+ T lymphocyte reduction. Comparing viral load with the presence or absence of SIL, stratified by quantification timing, there was a significant difference for values over 400 copies/mL (p=0.048; OR: 3.17; 95% CI: 1,02-9.93). No association was found between CD4+ T lymphocyte cell count and SIL. CONCLUSION: patients with HIV viral load higher than 400 copies/mL, performed before uterine cervical biopsy, showed a 3.17 times greater chance to develop SIL. CD4+ T lymphocyte count had no influence on the development of SIL.
Summary
Rev Bras Ginecol Obstet. 2005;27(3):106-111
DOI 10.1590/S0100-72032005000300002
PURPOSE: to evaluate CD4+ T lymphocyte cell count and HIV viral load influence on the presence of cervical squamous intraepithelial lesions (SIL). METHODS: cross-sectional study of 134 HIV-infected women submitted to uterine cervical biopsy, HIV viral load quantification and CD4+ T lymphocyte cell count. Viral load and CD4+ T lymphocyte cell count were performed before biopsy timing. Three different levels of viral load (<400 copies/mL; 401 to 50,000 copies/mL; >50,000 copies/mL) and CD4+ T lymphocyte count (<200 cells/mm³; 200 to 350 cells/mm³; >350 cells/mm³) were defined. Data were statistically analyzed by the chi2 test, linear tendency chi2 test, Mantel-Haenszel test, and analysis of variance, with level of significance set at p<0.05 and 95% confidence interval. RESULTS: there was no risk tendency for HIV-infected women to show SIL with viral load level increase or CD4+ T lymphocyte reduction. Comparing viral load with the presence or absence of SIL, stratified by quantification timing, there was a significant difference for values over 400 copies/mL (p=0.048; OR: 3.17; 95% CI: 1,02-9.93). No association was found between CD4+ T lymphocyte cell count and SIL. CONCLUSION: patients with HIV viral load higher than 400 copies/mL, performed before uterine cervical biopsy, showed a 3.17 times greater chance to develop SIL. CD4+ T lymphocyte count had no influence on the development of SIL.
Summary
Rev Bras Ginecol Obstet. 2006;28(6):345-351
DOI 10.1590/S0100-72032006000600005
PURPOSE: to evaluate association between CD4+ cell count and cervical intraepithelial lesion severity in HIV-infected women. METHODS: cross-sectional study of 87 HIV-infected patients which were confirmed by previous serologic examinations. All had cervical HPV diagnosed by polymerase chain reaction (PCR). All patients underwent anamnesis, physical examinations and colposcopy. Cervix biopsy was performed when indicated by colposcopical examination. Histopathological results followed Richart's classification, adapted by Wright, and CD4+ cell count and cervical intraepithelial lesion severity association was analysed by comparison of means using analysis using analysis of variance (ANOVA). RESULTS: among 60 biopsied women 24 were found (40.0%) with CIN I, eight (13.3%) with CIN II, three (5%) with CIN III, 14 (23.3%) with chronic cervicitis and 11 with cytopathic effect of HPV, without cell polarity loss. This corresponds to 35 (58.3%) women with intraepithelial lesion of low grade (CIN I + HPV) and 11 (18.3%) with intraepithelial lesion of high grade (CIN II + CIN III). There was no significant association between CD4+ cell count mean and cervical intraepithelial lesion severity (p=0.901). CONCLUSIONS: there was no association between CD4+ cell count and cervical intraepithelial lesion severity diagnosed by histopathological examination.
Summary
Rev Bras Ginecol Obstet. 2006;28(6):345-351
DOI 10.1590/S0100-72032006000600005
PURPOSE: to evaluate association between CD4+ cell count and cervical intraepithelial lesion severity in HIV-infected women. METHODS: cross-sectional study of 87 HIV-infected patients which were confirmed by previous serologic examinations. All had cervical HPV diagnosed by polymerase chain reaction (PCR). All patients underwent anamnesis, physical examinations and colposcopy. Cervix biopsy was performed when indicated by colposcopical examination. Histopathological results followed Richart's classification, adapted by Wright, and CD4+ cell count and cervical intraepithelial lesion severity association was analysed by comparison of means using analysis using analysis of variance (ANOVA). RESULTS: among 60 biopsied women 24 were found (40.0%) with CIN I, eight (13.3%) with CIN II, three (5%) with CIN III, 14 (23.3%) with chronic cervicitis and 11 with cytopathic effect of HPV, without cell polarity loss. This corresponds to 35 (58.3%) women with intraepithelial lesion of low grade (CIN I + HPV) and 11 (18.3%) with intraepithelial lesion of high grade (CIN II + CIN III). There was no significant association between CD4+ cell count mean and cervical intraepithelial lesion severity (p=0.901). CONCLUSIONS: there was no association between CD4+ cell count and cervical intraepithelial lesion severity diagnosed by histopathological examination.
Summary
Rev Bras Ginecol Obstet. 2001;23(6):355-364
DOI 10.1590/S0100-72032001000600003
Purpose: to compare histopathology and polymerase chain reaction (PCR) for the diagnosis of human papillomavirus (HPV) in cervical lesions of human immunodeficiency virus (HIV)-seropositive women. Methods: fifty-two HIV-seropositive women with suspected HPV cervical lesions were studied. Cervical scrapes were collected for PCR and colposcopy-guided biopsy was made for the histopathologic study. Three samples were disqualified for PCR, leaving a study population of 49 women. Results: the prevalence of HPV was 53% by histopathology and 85.7% by PCR. Among the 42 patients in whom HPV was detected by PCR, 26 were confirmed by histopathology (sensitivity = 61.9%). This method gave no false-positives (specificity = 100%), with 100% of positive prediction. Compared to PCR, the histopathology had: positive predcitive value = 100% and negative predcitive value = 30.4%. Among the 26 patients with HPV-positive biopsy, 15 (57.7%) had cervical intraepithelial neoplasia (CIN); relative risk = 13.3. Conclusion: histopathology was 100% correct for HPV-infection diagnosis. It means that when the biopsy is positive, HPV will be present, confirming the clinical suspicion. However, the low sensitivity excludes histopathology as a screening examination in this group of women.
Summary
Rev Bras Ginecol Obstet. 2001;23(6):355-364
DOI 10.1590/S0100-72032001000600003
Purpose: to compare histopathology and polymerase chain reaction (PCR) for the diagnosis of human papillomavirus (HPV) in cervical lesions of human immunodeficiency virus (HIV)-seropositive women. Methods: fifty-two HIV-seropositive women with suspected HPV cervical lesions were studied. Cervical scrapes were collected for PCR and colposcopy-guided biopsy was made for the histopathologic study. Three samples were disqualified for PCR, leaving a study population of 49 women. Results: the prevalence of HPV was 53% by histopathology and 85.7% by PCR. Among the 42 patients in whom HPV was detected by PCR, 26 were confirmed by histopathology (sensitivity = 61.9%). This method gave no false-positives (specificity = 100%), with 100% of positive prediction. Compared to PCR, the histopathology had: positive predcitive value = 100% and negative predcitive value = 30.4%. Among the 26 patients with HPV-positive biopsy, 15 (57.7%) had cervical intraepithelial neoplasia (CIN); relative risk = 13.3. Conclusion: histopathology was 100% correct for HPV-infection diagnosis. It means that when the biopsy is positive, HPV will be present, confirming the clinical suspicion. However, the low sensitivity excludes histopathology as a screening examination in this group of women.
Summary
Rev Bras Ginecol Obstet. 2008;30(9):437-444
DOI 10.1590/S0100-72032008000900003
PURPOSE: to verify the accuracy of uterine cervix cytology for HPV diagnosis, as compared to polymerase chain reaction (PCR) in samples of women with HIV. METHODS: 158 patients who had undergone a first collection of material from the uterine cervix with Ayre's spatula for PCR were included in the study. Then, another collection with Ayre's spatula and brush for oncotic cytology was performed. Only 109 slides were reviewed, as 49 of them had already been destructed for have being filed for over two years. RESULTS: the prevalence of HPV was 11% in the cytological exam and 69.7% in the PCR. Age varied from 20 to 61 years old, median 35 years. The HIV contagious route was heterosexual in 91.8% of the cases, and 79.1% of the patients had had from one to five sexual partners along their lives. The most frequent complaint was pelvic mass (5.1%), and 75.3% of the women had looked for the service for a routine medical appointment. The categorical variable comparison was done through contingency tables, using the χ2 test with Yates's correction to compare the ratios. The Fisher's test was used when one of the expected rates was lower than five. In the comparison of diagnostic tests, sensitivity, specificity and similarity ratios have been calculated. Among the 76 patients with HPV, detected by PCR, only 12 had the diagnosis confirmed by cytology (sensitivity=15.8%), which on the other hand did not present any false-positive results (specificity=100%). Concerning the HPV presence, the cytological prediction for positive results was 100% and 33.3% for negative, when both results were compared. Among the 12 patients with HPV positive cytology, four (33.3%) presented cervical intraepithelial neoplasia (OR=56; positive similarity ratio=positive infinity; negative similarity ratio=0.83). CONCLUSIONS: As the cytology specificity is quite high, it is possible to rely on the positive result, which means that a positive result will surely indicate the presence of HPV. The low sensitivity of cytology does not qualify it as a survey exam for HPV detection in this female group.
Summary
Rev Bras Ginecol Obstet. 2008;30(9):437-444
DOI 10.1590/S0100-72032008000900003
PURPOSE: to verify the accuracy of uterine cervix cytology for HPV diagnosis, as compared to polymerase chain reaction (PCR) in samples of women with HIV. METHODS: 158 patients who had undergone a first collection of material from the uterine cervix with Ayre's spatula for PCR were included in the study. Then, another collection with Ayre's spatula and brush for oncotic cytology was performed. Only 109 slides were reviewed, as 49 of them had already been destructed for have being filed for over two years. RESULTS: the prevalence of HPV was 11% in the cytological exam and 69.7% in the PCR. Age varied from 20 to 61 years old, median 35 years. The HIV contagious route was heterosexual in 91.8% of the cases, and 79.1% of the patients had had from one to five sexual partners along their lives. The most frequent complaint was pelvic mass (5.1%), and 75.3% of the women had looked for the service for a routine medical appointment. The categorical variable comparison was done through contingency tables, using the χ2 test with Yates's correction to compare the ratios. The Fisher's test was used when one of the expected rates was lower than five. In the comparison of diagnostic tests, sensitivity, specificity and similarity ratios have been calculated. Among the 76 patients with HPV, detected by PCR, only 12 had the diagnosis confirmed by cytology (sensitivity=15.8%), which on the other hand did not present any false-positive results (specificity=100%). Concerning the HPV presence, the cytological prediction for positive results was 100% and 33.3% for negative, when both results were compared. Among the 12 patients with HPV positive cytology, four (33.3%) presented cervical intraepithelial neoplasia (OR=56; positive similarity ratio=positive infinity; negative similarity ratio=0.83). CONCLUSIONS: As the cytology specificity is quite high, it is possible to rely on the positive result, which means that a positive result will surely indicate the presence of HPV. The low sensitivity of cytology does not qualify it as a survey exam for HPV detection in this female group.
Summary
Rev Bras Ginecol Obstet. 2003;25(9):661-666
DOI 10.1590/S0100-72032003000900007
PURPOSE: to present the most frequent gynecologic results in a cohort of 300 outpatient HIV-infected women. METHODS: this is a prospective and descriptive study of HIV-infected women that have been followed up at the gynecological clinic from November 1996 to December 2002. These patients were subjected to a specific protocol which included an interview, a gynecological evaluation and a collecting cervical sample for Pap smear, research of HPV (PCR) and colposcopy. Cervical biopsy was performed when necessary. Data were stored and analyzed by Epi-Info, version 6.0. RESULTS: the mean age was 34.5 years. The small number of sexual partners, average of three partners, and the predominance of heterosexual contagion should be mentioned: 271 (90.6%) patients were contaminated through sexual contact with their partners. There was a high prevalence of cervical intraepithelial neoplasia (CIN) representing 21.7% of the total group. Of 109 patients subjected to PCR, 89 (81.7%) were found to have some HPV genotype. An inflammatory smear was present in 69% of the patients. CONCLUSIONS: there is a high frequency of CIN and genital infectious diseases among HIV-infected women, mainly HPV.
Summary
Rev Bras Ginecol Obstet. 2003;25(9):661-666
DOI 10.1590/S0100-72032003000900007
PURPOSE: to present the most frequent gynecologic results in a cohort of 300 outpatient HIV-infected women. METHODS: this is a prospective and descriptive study of HIV-infected women that have been followed up at the gynecological clinic from November 1996 to December 2002. These patients were subjected to a specific protocol which included an interview, a gynecological evaluation and a collecting cervical sample for Pap smear, research of HPV (PCR) and colposcopy. Cervical biopsy was performed when necessary. Data were stored and analyzed by Epi-Info, version 6.0. RESULTS: the mean age was 34.5 years. The small number of sexual partners, average of three partners, and the predominance of heterosexual contagion should be mentioned: 271 (90.6%) patients were contaminated through sexual contact with their partners. There was a high prevalence of cervical intraepithelial neoplasia (CIN) representing 21.7% of the total group. Of 109 patients subjected to PCR, 89 (81.7%) were found to have some HPV genotype. An inflammatory smear was present in 69% of the patients. CONCLUSIONS: there is a high frequency of CIN and genital infectious diseases among HIV-infected women, mainly HPV.