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P1-S5.28 Cervical cytology and histopathologic abnormalities in women living with AIDS in SAo Paulo, Brazil

2011; BMJ; Volume: 87; Issue: Suppl 1 Linguagem: Inglês

10.1136/sextrans-2011-050108.206

1472-3263

Valdir Monteiro Pinto, Ana Espinosa, Mariza Vono Tancredi, Jonathan E. Golub, Rúbia Aguiar Alencar,

Cervical Cancer and HPV Research

Background Women living with HIV/AIDS present with a higher prevalence of HPV infection, higher rates of squamous intraepithelial lesions (SIL), and are more susceptible to invasive cervical carcinoma progression. Objective We assessed frequency of precursory cervical lesions of cancer and its risk factors for women living with HIV/AIDS. Methods Sociodemographic, clinical, behaviour and laboratory data were collected from medical records from 2008 to 2009 and analysed using forward stepwise logistic regression. Results Medical records of 631 women were reviewed; mean age at AIDS diagnosis was 34 years old (IQR=29–40 years old), 32% were <16 years old at first sexual intercourse; 61% had ≤5 sexual partners during life; 43% had been living with AIDS for ≥9 years; 47% reported previous sexually transmitted infections; 44% presented with HPV infection and 10% presented with high squamous intraepithelial lesions (HSIL). Presenting HSIL was significantly associated with home district Human Development Index, age at AIDS diagnosis (>40 years old), time of AIDS diagnosis (>8 years), CD4 cell count <350/mm 3 and HPV infection see Abstract P1-S5.28 Tables 1, 2 & 3. Abstract P1-S5.28 Table 1 Sociodemographic characteristics of women living with AIDS—São Paulo, Brazil, from 2008 to 2009 Characteristics High-grade lesions Yes (n=64) No (n=567) Total (n=631) p n % n % n % Age (at AIDS diagnosis) <0.001 Up to 40 years old 31 48.4 428 75.5 459 72.7 >40 years old 33 51.6 139 24.5 172 27.3 64 100.0 567 100.0 631 100.0 Years of education 0.712 None 1 1.6 6 1.1 7 1.1 1–4 years 5 7.8 45 7.9 50 7.9 5–8 years 27 42.2 226 39.9 253 40.1 9–11 years 26 40.6 210 37.0 236 37.4 12 or more 4 6.3 75 13.2 79 12.5 Unknown 1 1.6 5 0.9 6 1.0 64 100.0 567 100.0 631 100.0 Race (self-referred) 0.005 White 33 51.6 360 63.5 393 62.3 Black 27 42.2 199 35.1 226 35.8 Others 4 6.3 5 0.9 9 1.4 Unknown 0 0.0 3 0.5 3 0.5 HDI of home district <0.001 >0.500 8 12.5 423 74.6 431 68.3 0–0.500 56 87.5 144 25.4 200 31.7 Abstract P1-S5.28 Table 2 Behaviour and Clinical Characteristics of women living with AIDS – São Paulo, Brazil, from 2008 to 2009 Characteristics High-grade lesions Yes (n=64) No (n=567) total (n=631) p n % N % n % Age at first sexual intercourse 0.074 Up to 16 years old 27 42.2 180 31.7 207 32.8 More than 16 years old 28 43.8 332 58.6 360 57.1 Unknown 9 14.1 55 9.7 64 10.1 64 100.0 567 100.0 631 100.0 Lifetime number of sexual partners 0.058 1 to 2 8 12.5 133 23.5 141 22.3 3 to 5 24 37.5 218 38.4 242 38.4 6 and more 20 31.3 107 18.9 127 20.1 Unknown 12 18.8 109 19.2 121 19.2 64 100.0 567 100.0 631 100.0 STI <0.001 No 1 1.6 301 53.1 302 47.9 Yes 63 98.4 233 41.1 296 46.9 Unknown – – 33 5.8 33 5.2 64 100.0 567 100.0 631 100.0 HPV cytological changes <0.001 No 2 3.1 351 61.9 353 55.9 Yes 62 96.9 216 38.1 278 44.1 64 100.0 567 100.0 631 100.0 (HSV-2) 0.969 No 51 79.7 453 79.9 504 79.9 Yes 13 20.3 114 20.1 127 20.1 Time of AIDS diagnosis <0.001 1 to 8 years 16 25.0 345 60.8 361 57.2 9 years or more 48 75.0 222 39.2 270 42.8 CD4 Cell counting <0.001 >500 cell/mm 3 1 1.6 126 22.2 127 20.1 350–500 cell/mm 3 10 15.6 234 41.3 244 38.7 <350 cell/mm 3 53 82.8 207 36.5 260 41.2 64 100.0 567 100.0 631 100.0 Abstract P1-S5.28 Table 3 Bi and multivariate analysis of associated factor for high-grade lesion of women living with AIDS – São Paulo, Brazil, 2008 to 2009 Users characteristics Bivariate analysis Multivariate analysis OR (95% CI) p OR aj 95% CI p HPV cytological changes No 1 – 1 – Yes 50.4 (12.2 to 208.0) <0.001 68.6 (11.6 to 404.6) <0.001 CD4 + Cell counting > 500 cell/mm 3 1 – 1 – 350–500 cell/mm 3 5.4 (0.7 to 42.5) 0.11 0.74 (0.1 to 7.3) 0.799 < 350 cell/mm 3 32.3 (4.4 to 236.2) 0.001 24.5 (2.7 to 224.9) 0.005 HDI of home district >0.500 1 – 1 – 0–0.500 20.6 (9.6 to 44.2) <0.001 3.3 (1.1 to 10.8) 0.047 Time of HIV diagnosis (years) 1 to 8 years 1 – 1 – >8 years 4.7 (2.6 to 8.4) <0.001 2.9 (1.3 to 6.5) 0.012 Age level (for AIDS diagnosis) Up to 40 years old 1 – 1 – > 40 years old 3.3 (1.9 to 5.5) <0.001 2.7 (1.2 – 6.0) 0.019 # Lifetime Sexual partners – – 1 to 2 1 – 3 to 5 1.8 (0.80 to 4.19) 0.153 6 and more 3.1 (1.32 to 7.33) 0.010 STI – – No 1 – Yes 48.8 (6.71 to 354.2) <0.001 Race (self-referred) White 1 – – – Black 1.5 (0,86 to 2.53) 0.153 Others 8.7 (2.23 to 34.1) 0.002 OR: OR (non adjusted), OR aj: OR adjusted. Conclusions Frequent squamous intraepithelial neoplasia in these women shows the importance of gynaecologic exams in routine care and follow-up required by those who present with cervical lesions.