Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

326 Abstracts 22315-22318

12th World AIDS Conference

(15.7%), stabilization in 3/19 (15.7%) and extension in 2/19 (10.7%) after 3 to 6
months of treatment.
Conclusion: The high prevalence of condyloma and dysplasia emphasizes
the importance of the anogenital examen in HIV-positive patients. In case of anal
lesions, anuscopy and biopsy are required. We insist about the necessity of a
close survey of these patients. Anal cytology should be developped for depistage
and prevention of the malignant transformation of HPV lesions.
S22315 1 Human papilloma virus (HPV) in HIV+ women:
An assessment of infection rates and treatment
outcomes
Maryjo Fink, E.J. Degnan. Albany Medical College A-158, Albany, New York,
USA
Objective: To investigate the clinical significance of HPV infection and treatment
outcomes in women with HIV/AIDS.
Methods: The sample (n = 364), comprised of HIV seropositive women (mean
age: 36 y; range: 15 to 61 y) from urban and rural upstate New York, USA were
followed for women's health care at an AIDS designated center. Detailed medical
histories were obtained and physicals performed at 6-12 month intervals and
included screening genital cultures and PAP testing. Colposcopy followed when
indicated. Biopsies were taken of suspicious lesions or following an abnormal
PAP test, defined as "atypia" or "cervical intraepithelial neoplasia" (CIN). HPV was
diagnosed based on cervical or vulvar histology or on the presence of anogenital
condyloma. Treatments included: colposcopy and serial biopsy for HPV and CIN1;
LEEP for CIN2, CIN3, CIS; hysterectomy for recurrent high grade cervical lesions
following LEEP; LASER or modified vulvectomy for vulvar lesions.
Results: The women were seen for 1 to 10 visits (mean: 3); over the 4 year
observation period, 41 women died and 69 moved or were lost to follow-up.
Forty-five percent of the sample (n = 162) were diagnosed with HPV. Of these,
30% (n = 50) had high grade lesions; recurrence of high grade lesions was
noted in 11 patients. Treatments included: 50 LEEPs, 4 hysterectomies, 9 vulvar
treatments, including 3 modified vulvectomies. One complication of post-LEEP
bleeding necessitating transfusion was noted. Among the 50 patients with high
grade lesions, there have been 6 deaths, none attributable to cervical or vulvar
cancer.
Conclusion: HPV is a common infection in HIV+ women and detection should
be a primary focus of screening protocols based on our results. Treatment options for high grade lesions are complicated by HPV recurrence and limitations of
cervical anatomy. In this sample hysterectomy for recurrent high grade lesions is
one option that did not carry additional morbidity or mortality.

I22317 Relationship of HIV-1 RNA copies in plasma and CD4
counts to human papillomavirus (HPV) prevalence and
cervical dysplasia
Keerti Shah1, H. Farzadegan1, R. Daniel1, R. Klein2, A. Duerr3, D. Warren3
B. Kieke3, L. Braun4, R. Burk5, P. Schuman6. Johns Hopkins School of Public
Health, 615 N. Wolfe St., Baltimore, MD; 2Montefiore Medical Centers, New
York, NY; 3Centers for Disease Control, Atlanta, GA; 4Brown University,
Providence, RI; 5Albert Einstein College of Medicine, Bronx, NY; 6Wayne State
University, MD, USA
Background: HIV-infected women are at high risk of cervical neoplasia. We
enquired into the contributions of HIV-induced immunosuppression to this risk.
Design: Cross-sectional study (using baseline data) of HIV-infected women
without any AIDS-defining illness (n = 561) and HIV-negative women with similar risk factors (n = 321) participating in the multisite HER (HIV epidemiology
research) study.
Methods: HIV status measured by plasma HIV RNA copies by super-sensitive
bDNA assay, and by CD4 counts; cervical dysplasia by Pap smear; and HPV
prevalence by polymerase chain reaction (PCR) assay.
Results: Nearly identical results were obtained with both measures; about
3-fold rise in HPV prevalence, 7-8 fold rise in low grade squamous intraepithelial
lesions (LSIL), and about 2-fold rise in high grade SIL (HGSIL). HPVs were
identified in over 95% of SILs of both immunocompetent and immunosuppressed
women. Highest risk HPVs (16, 18, 31 and 45) constituted 6%, 43% and 62% of
HPVs, respectively, in women with normal, LSIL, and HSIL cytology (p < 0.0001).

Percent of specimens
N HPV LSIL

HIV-1 RNA copies
HIV+ >30,000
HIV+ 10-30,000
HIV+ 200-9,999
HIVf+ undetect
HIVP for trend
CD4 count
HIV+ <200
HIV+ 2-500
HIV+ -500
HIV
P for trend

52
61
236
212
321
89
287
185
321

79
74
67
50
28
0.001
81
66
48
28
0.001

33
23
11
9
4
0.001
30
15
5
4
0.001

HSIL
3.8
0
3.8
3.3
1.9
NS
3.4
3.1
3.2
1.9
NS

22316I

Prevalence of squamous intraepithelial lesions (SIL) and
human papiloma virus (HPV) in HIV-positive and
HIV-negative Mexican women: Case control study

Patricia Volkow1, Juan Sierra-Madero2, S. Rubi3, M. Lizano-Soberon3,
A. Carrillo-Garcia3, D. Vilar-Compte3, R. Sotelo3, A. Mohar Betancourt3. 'Av.
San Fernando 22 Mexico 14000; 2 nstituto Nacional De La Nutricion Mexico D.F
14000; 3 nstituto Nacional De Cancerologia Mexico D.F 14000, Mexico
Background: VPH has been assosiated with SIL and Cervical Carcinoma, the
interaction between decreased celullar immunity and VPH has been recognized.
The coinfection with HIV and HPV is a growing problem in Mexican women, as
HIV infection in the last seven years is predominatly heterosexual and cervical
carcinoma is highly prevalent in Mexico.
Objective: To determine the prevalence of HPV infection, specific subtypes
and risk factors in HIV infected and non infected Mexican women and to correlate
the presence of SIL with immunologic status.
Methods and Patients: Cases were HIV infected women who accepted to
participate. Controls were HIV-women from voluntary HIV screening centers in
Mexico City and non-infected women with an HIV+ partner. Clinical and demografic data were obtained, gynecologic examination, Pap smear, colposcopy
with directed biopsy and endocervical sample with cytobrush for HPV detection
were obtained. HPV was detected using PCR and hybrid capture and subtypng
was performed using specific primers.
Results: Forty one cases (83% sexually acquired, 10% transfusion acquired
and 2.4% paid plasma donors) and 40 controls were included. No differences in
age or age at first sexual intercourse were seen between both groups. Histologic
high grade SIL were found in 9 cases (22%) and 4 (10%) controls (p = 0.21), low
grade in 16 (39%) and 5 (12%) respectively (p = 0.03). HPV was detected in 36
(90%) cases of which 18 belonged to high risk subtypes (16, 18, 45 and 66) and,
5 to intermediate risk subtypes (35, 58, 59 and 68). Two unknown risk subtypes
72 and CP8304 were detected in four patients, two of whom had SIL. High grade
SIL was found in 6 of 19 patients with CD4 cell count <200 and in 2 of 20 with
>200 (p = 0.1).
Conclusions: HPV infection and SIL are highly prevalent in HIV infected Mexican women. This is one of the highest reported prevalence among different
populations.

for values of HIV+ women
Conclusions: Increased plasma HIV RNA and decreased CD4 counts were
similarly associated with increased prevalence of HPVs and of cervical dysplasia. Pap smear abnormalities were more frequent, but not more severe, in
immunosuppressed women.
S22318 Cervical intraepithelial changes and HIV infection in
women attending STD clinics in Pune, India
Smita Joshi1, A. Chandorkar2, S.M. Mehendalel, R.R. Gangakhedkar',
S.N. Gaikwad1, D.A. Gadkaril, R.C. Bollinger3. 1National AIDS Research
Institute, Pune; 2Sanjeevan Hospital, Pune, India; 3John Hopkins University,
Baltimore MD, USA
Background: Cervical Cancer is preceded by intraepithelial histopathologic
changes. Studies in the west have shown that there is a 8 to 10 fold rise in
cervical dysplasias in young HIV infected women. Ca Cervix is the most common
malignancy among females in India. This study was undertaken to assess the
risk of development of cervical intraepithelial changes amongst females attending
two HIVNET STD Clinics in Pune, India.
Methods: Demographic, behavioral, and clinical assessment along with Pap
smears examination was performed on consecutive female patients attending
two STD clinics as a part of ongoing HIVNET study between July 96 to Jan 98.
These smears were stained by Papnicolous stain and interpreted by a pathologist
blinded to the HIV status of patients using Bethesda scale.
Results: Of the 170 female patients screened so far, 70 were HIV positive
(41.2%). Of the 70 HIV infected women 7 patients had mild to moderate dysplasia,
8 patients had ASCUS pap smears, 23 patients had Inflammatory cytology and
32 patients had normal cytology. Out of 100 HIV negative women, 5 patients
had mild to mod. Dysplasia, 2 had ASCUS pap smears, 30 had Inflammatory
cytology and 63 had normal cytology. The odds of not detecting any abnormality
in the cervix amongst HIV negative women (O.R. 0.52 (95% C.I. 0.28, 0.96; p
= 0.03) was significantly different as compared to HIV infected women. The risk
of having cervical dysplasia was 2.12 times higher in HIV infected women (p =
0.21). There was no statistical difference amongst sex worker and other women
& in age groups.
Conclusion: The risk of having an abnormal papsmear in HIV positive women
is two times higher that of HIV negative women. As cancer cervix contributes the
highest to the cancers in women and alarming rise of HIV infection even in low
risk women in India, yearly Pap smear examination is essential in HIV infected
women. Further studies are required to assess the underlying risk for CIN in HIV
infected women.