Reports on HIV/AIDS: 1990

NOVEMBER 30, 1990, MMWR, Vol. 39, No. 47, pp. 846-849
Risk for Cervical Disease in HIV-lnfected Women -
New York City
Recent reports have suggested an association between human immunodeficiency
virus (HIV) infection and cervical disease in women (1-5). This report summarizes
findings from four studies in New York City that assessed the risk for cervical disease
in women infected with HIV (6-10).
Among patients receiving care from two ambulatory-care clinics for HIV-infected
women, the prevalence of cervical dysplasia on Papanicolaou (Pap) smear for
HIV-positive women was eight and 11 times greater than the prevalence of dysplasia
for women residing in the respective communities (6). Specifically, among clinic
patients, the proportions of HIV-positive women with dysplasia were 32% (10/31) and
33% (6/18); in contrast, among women in the communities, the prevalences of
cervical dysplasia were 4% and 3%, respectively.
The association of HIV infection with cervical squamous intraepithelial lesions
(SIL)* and human papillomavirus (HPV) infection of the cervix was prospectively
investigated in 132 women attending a methadone maintenance clinic (7,8). Evidence
for HPV infection was detected in 67% of symptomatic HIV-positive women, 31% of
asymptomatic HIV-positive women, and 27% of HIV-negative women. HPV was more
strongly associated with SIL in symptomatic (odds ratio [OR]= 29.3; 95% confidence
interval [CI]= 1.6-551.9) and asymptomatic (OR =8.8; 95% Cl= 1.6-47.8) HIV-positive
women than in HIV-negative women (OR= 2.3; 95% C= 0.5-11.7). In women who
were not infected with HPV, no association was found between HIV and SIL. The
findings of this investigation suggest that HIV-induced immunosuppression may
predispose to HPV-mediated cervical cytologic abnormalities.
The characteristics of cervical disease were assessed in women with known HIV
status attending a medical center for evaluation of abnormal Pap smears (9).
Colposcopic evaluations of 77 patients suggested that cervical intraepithelial neoplasia (CIN) was more severe and extensive in 25 HIV-positive women than in 52
HIV-negative women. Among the HIV-positive women, CIN was a higher grade and
more likely to involve multifocal or extensive cervical lesions, multiple sites of the
lower genital tract, and the perianal area. The investigators also reported that in a
group of 37 patients who were <50 years of age and who had invasive cervical
carcinoma, seven (19%) were HIV-positive. The seven HIV-positive patients had more
advanced stages of disease and poorer outcomes following therapy than the 30
HIV-negative patients. These findings suggest that HIV infection may influence the
rate of progression of both preinvasive and invasive cervical neoplasia.
Finally, among 32 HIV-infected women who were evaluated for cervical disease by
Pap smear and colposcopically directed biopsies (10), three (9.4%) had abnormal
cytology on Pap smear; however, for 27 (84.4%), histology was abnormal on biopsy,
including 13 (40.6%) with CIN and 14 (43.8%) with chronic cervicitis. The findings of
this study suggest that, in HIV-positive women, Pap smear and cervical biopsy results
may correlate poorly.
*Low-grade SIL encompass cellular changes associated with human papillomavirus and mild
dysplasia/cervical intraepithelial neoplasia (CIN) 1; high-grade SIL include moderate dysplasia/
CIN 2, severe dysplasia/CIN 3, and carcinoma-in-situ/CIN 3 (11).

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