Low-grade squamous intraepithelial lesions among women with HIV

Abstract

Objectives: To assess whether women with HIV who had low-grade squamous intraepithelial lesions (LSIL) on cytology had cervical disease.

Methods: The present retrospective cross-sectional study included data from women with LSIL who attended a tertiary hospital in South Africa between April 1, 2003, and December 31, 2013. Patient information was extracted from a colposcopy database.

Results: The study included 652 patients. The median age was 36 years (interquartile range [IQR] 31-42 years; range 18-66 years) and the median parity was three (IQR 2-5; range 0-10). In all, 266 (40.8%) women had a histology result of HPV or cervical intraepithelial neoplasia 1 (CIN1); 386 (59.2%) had a histology result of CIN2 or higher. The median cluster of differentiation 4 (CD4) count was 275.00 cells/mm³ (IQR 173.50-434.00 cells/mm³ ; range 2-1211 cells/mm³ ). A total of 312 (47.9%) women were using antiretroviral therapy. Use of antiretroviral therapy (unadjusted odds ratio 0.57; P=0.001) and a CD4 count of at least 200 cells/mm³ (unadjusted odds ratio 0.81; P=0.002) were associated with a histology result of HPV or CIN1.

Conclusion: Most of the women with a cytology report of LSIL had CIN2 or higher, suggesting that the practice of referral for colposcopy should continue.

Keywords: Cervical cancer precursor lesions; Cervical intraepithelial neoplasia; HIV; LSIL; Papanicolaou; South Africa.