Screening for cervical carcinoma in HIV-infected women: Analysis of main risk factors for cervical cytologic abnormalities

AimThe aim of this study was to identify potential predictive factors for cervical disease in women with HIV and to evaluate adherence during follow-up to cervical cancer screening. MethodsIn order to identify the independent role of factors associated with the presence of a cervical abnormality, all of the variables showing in univariate analyses a potential association with the outcome variable (presence of cervical abnormalities) were entered into a multivariate logistic regression model, along with age at first visit to our center, and age at diagnosis. ResultsA total of 540 HIV-positive women who received screening for cervical cancer during the first year after their first visit to our center were included in the analysis; 423 (78.3%) had normal cytology and 117 (21.7%) had cytological abnormalities, classified as follows: 21 atypical squamous cells of undetermined significance (17.9%); 51 low-grade squamous intraepithelial lesions (43.6%); 41 high-grade squamous intraepithelial lesions (35.0%); and four cervical cancers (3.4%). In our study, women with more than two previous pregnancies were significantly associated with a lower risk of cervical cytological abnormalities compared to the other women. Women with CD4+ levels of 200-499/mm(3) had a higher risk of developing cervical cytological abnormalities compared to those with a CD4+ level>500/ mm(3). ConclusionIn summary, management of HIV-positive women must be modeled on HIV-clinical status, CD4+ cell count, drug regimen, and adherence to follow-up, relying on the cooperation of highly qualified professionals. In HIV-positive women, an adequate screening and follow-up allows for a reduced occurrence of advanced cervical disease and prevents recourse to invalidating surgical interventions.