Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

472 Abstracts ThPeC7546-ThPeC7550

XIV International AIDS Conference

ThPeC7546 Antigen presenting cells and distribution of
HLA-DR and DQ molecules in HIV+ patients with
squamous intraepithelial lesions
M.A.G. Gongalves, A.P.M. Fernandes, A. Ribeiro-Silva, S.M. Quintana,
G. Duarte, E.A. Donadi. University of Sdo Paulo, Sio Paulo, Brazil
Background: HIV+ women are more susceptible to present lower genital tract
neoplasia, especially cervical tumors. The higher incidence of squamous intraepithelial lesions (SIL) has been correlated with the progression of immunosuppression. Up to now, few studies have been reported in HIV+ patients evaluating the
qualitative and quantitative analysis of infiltrating immune cells in SIL biopsies.
Methods: To analyse the local immunological profile according to the severity of
SIL we evaluated cervical specimens collected from 32 HIV+ and 42 HIV- control
patients presenting with low- or high-grade SIL. The number of Langerhans cells
(LC) (S100+ cells) and of cells bearing surface HLA DR and HLA DQ molecules
was evaluated by immunohistochemical procedures.
Results: Preliminary data showed that biopsies from HIV+ group presented fewer
LC when compared to the HIV- group. HIV+ women with low-grade SIL exhibited
4 times more LC compared with high-grade SIL. In contrast, the ratio of LC in
low and high-grade SIL was 1.63 in HIV- patients. Among HIV+ patients, a focal
stromal distribution of HLA DR+ cells was observed near high-SIL area, whereas
a diffuse distribution was observed in low-grade SIL. No significant differences
were found with respect to HLA DQ+ cells in low/high SIL groups.
Conclusions: As HIV+ patients are frequently under exposition to human papillomavirus (HPV) infections and CD4 variations, local impaired control of the
immune response facilitates the increased prevalence of SIL. The evaluation of
additional markers in these series of patients are still in progress in our lab. These
results may help the understanding of the immunological mechanisms underlying
the development of SIL.
Acknowledgments: To FAPESP (01/02908-2) for the financial support and for the
excellent technical assistance of Mrs.Ana Maria Anselmi Dorigan.
Presenting author: maria alice g. goncalves, r. floriano peixoto, 1506, ribeirao
preto, sao paulo, Brazil, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
ThPeC7547 Lower genital tract dysplasiain HIV-infected
women with cervical dysplasia
P. Paramsothy1, A. Duerr2, S. Cu-Uvin3, J. Anderson4, R.S. Klein5,
P. Schuman6. 1CONRAD/CDC, Atlanta; 2Centers for Disease Control and
Prevention, Atlanta, GA; 3Department of Obstetrics and Gynecology Brown
University, Providence, United States; 4Johns Hopkins University School of
Medicine, Baltimore, United States; 5Montefiore Medical Center and Albert
Einstein College of Medicine, Bronx, United States; 6 Wayne State University
School of Medicine, Detroit, United States
Background: Higher rates of genital tract HPV-associated dysplasia and more
frequent relapse after treatment have been documented in HIV-infected (HIV+)
women. Prior cervical HPV disease may indicate increased risk for vaginal or
vulvar intraepithelial neoplasia (VAIN or VIN) in HIV+ women with hysterectomy.
Methods: Data on cervical and post-hysterectomy vaginal Pap smears, colposcopy and biopsies from semiannual visits (1993-2000) were analyzed for 26
HIV+ U.S. women who participated in the HIV Epidemiology Research study and
had a hysterectomy during the study.
Results: 17 of 26 women (65%) had cytologic or histologic evidence of cervical dysplasia at or before hysterectomy. After hysterectomy, SIL was noted on
a subsequent vaginal smear for 11/17 (65%) women with prior cervical dysplasia (median follow-up 34 m) and 1/9 (11%) women without prior cervical dysplasia
(median follow-up 37 m) (OR=1 5, p=.01). Risk of SIL on vaginal smear was higher
in women with HPV or low CD4 count at time of hysterectomy (6/6 with CD4<200
cells/VL had SIL during follow-up) but was not significantly related to age or the
time from first detection of cervical SIL to hysterectomy (p=0.07, 0.13, respectively). Vaginal and vulvar biopsies from 7 women with prior cervical dysplasia
showed: normal finding in 1, VAIN I in 2, VAIN II in 1, and VAIN III in 3. Biopsies
from 2 women without prior cervical dysplasia showed: VAIN I and VAIN I plus
VIN I.
Conclusions: The high rates of vaginal SIL and VAIN Il/111 after hysterectomy in
HIV+ women with prior cervical dysplasia suggest regional HPV disease in these
women. Lower genital tract monitoring may be warranted for HIV+ women with
documented cervical HPV disease.
Presenting author: Pangaja Paramsothy, Centers for Disease Control and Prevention, Mailstop K34, 4770 Buford Hwy. NE., Atlanta, Ga 30341, United States,
Tel.: [phone], Fax: [phone], E-mail: [email protected]

ThPeC7548I Frequent detection of cervical intraepithelial
neoplasia among immigrant HIV positive Ethiopian
women in Jerusalem: A proactive diagnostic
approach
R. Arbel1, M. Hauzi, H. Nagusa2, E. Rubinstein', R. Kochman-Haimov1,
V. Eisenberg1, T. Goslitzer', S. Maayan1. 1Hospital, Hadassah Hospital AIDS
Center, Jerusalem, Israel; 2Institution, Jerusalem, Israel
Background: Seventy seven of the 87 (88.5%) HIV+ women currently followed in
Jerusalem are recent Ethiopian immigrants. As a whole, this group faces extreme

stress due to the immigration process itself and the social stigma associated with
being HIV+. The group includes many discordant couples and single mothers.
Consequently, these women tend to assign a low priority to their own health in
general and to invasive gynecological procedures in particular.
Since cervical carcinoma is the most prevalent gynecological cancer in subSaharan Africa, we attempted to proactively (i.e: staff initiated) offer routine pap
smears to all HIV+ immigrant women.
Methods: Immigrant sero+ women were repeatedly counseled by an Ethiopian
female member of the staff, in a cultural and gender sensitive manner, regarding
the importance of pap smears.
Results: 29 of the 77 HIV+ women (38%) visited the OBGYN-HIV clinic over a
one year period. Of these, 6 (21%) were found to have cervical intraepithelial neoplasia (cin); 4 (14%) had high grade squamous intra- epithelial lesions (HGSIL)
and 2 (7%) had low grade SIL. Three of 6 HIV+ women with cervical pathology underwent hysterectomy/conization. No cervical pathology was observed among 10
HIV seronegative Ethiopian women sampled at a regional OBGYN clinic. Lower
CD4 counts were noted among HIV + women with CIN (232 cells +1.57) than
among HIV+ women with normal cervix (327 cells +5.9, p=ns).
Conclusions: 1.High rate of CIN with high proportion of HGSIL was detected in
an incidental cohort of HIV + immigrant Ethiopian women.
2.The lower mean CD4 in the HIV+/CIN+ than in the HIV+/CIN- may suggest a
trend which needs corroboration in a larger cohort.
3.Culture-and gender-sensitive proactive routines towards pap smears are required in this unique population to facilitate the detection of the frequent and serious CIN cervical pathology.
Presenting author: Shlomo Maayan, Hadassah Hospital AIDS Center,
Jerusalem, Israel, Tel.: [phone], Fax: [phone], E-mail: shiomom
@netvision.net.il
ThPeC7549I High prevalence of genital intra-epithelial neoplasia
in a cohort of HIV infected women in Rio de Janeiro
(RJ), Brazil
F. Russomanol, F.I. Bastos2, M.J. Camargo3, A.L. Almada-Horta4,
J. Chicarino-Coelho5, V.G. Veloso6, M. Derrico5, A. Andrade5, R. Friedman5,
S. Aidee-Fialho 7, J.H. Pilotto5, B. Grinszteon8. 'Fernandes Figueira Institute -
Fiocruz, Rio de Janeiro, Brazil; 2CICT - Fiocruz, Rio de Janeiro, Brazil;
3Fernandes Figueira Institute - Fiocruz, Rio de Janeiro, Brazil; 4Laboratorio
Almada Horta, Rio de Janeiro, Brazil; 5Evandro Chagas Hospital Research
Center - Fiocruz, Rio de Janeiro, Brazil; 6Evandro Chagas Hospital Research
Center and Rio de Janeiro State AIDS Program, Rio de Janeiro, Brazil; 7'IFF -
Fiocruz, Rio de Janeiro, Brazil; 8Evandro Chagas Hospital Research Center -
Fiocruz and SMS - Rio de Janeiro, Av das Americas 3555 b/ 2 sala 302 Rio de
Janeiro Brazil 22631-003, Brazil
Background: Cervical neoplasia occurs with increased frequency among women
infected with HIV-1.In Brazil, cervical cancer is still a major public health issue
and there is scarce available data about gynecologic manifestations among HIV
infected women in our country
Methods: In the baseline evaluation of an ongoing cohort study, 297 HIV+ women
from a Clinical Research Institute in RJ were interviewed, underwent a Pap smear
and human papillomavirus (HPV) DNA test and were referred for colposcopy
Results: Cervical cytology was abnormal in 17.8% of HIV-infected women (atypical squamous cells of undetermined significance [ASCUS] - 1.7%; low-grade
squamous intraepithelial lesion [LSIL] - 11.4%; high-grade squamous intraepithelial lesion [HSIL] - 4.4%; cancer - 0.3%). Roughly 82% (244) women underwent
colposcopy, with a final prevalence of 25.6% for HPV/NIC I and 11.6% for NIC
II/Ill; 2 (1.1%) cases of high-grade vaginal intraepithelial neoplasia (VAIN II/Ill);
and 8 (5.3%) cases of high-grade vulvar intraepithelial neoplasia (VAIN 11/111).
High-risk HPV DNA was detected in 93.8% of those diagnosed with NIC II/IIIN/VAIN
III, in 63.6% of the NIC I and in 32.5% of the colposcopically negative patients
Conclusions: Human papillomavirus-associated disease was highly prevalent in
this cohort, and was more likely to be multicentric and involves the vulva, vagina,
and cervix. Detection of high-grade VIN in 8 and high-grade VAIN in 2 of these
HIV+ women suggests they may also be at risk for developing invasive vulvar and
vaginal carcinoma. The high prevalence of high-risk oncogenic HPV in women
with negative colposcopic diagnosis points out to a potential risk of developing
genital HPV-related neoplasia even in those women without detectable lesions
and emphasizes the need of a comprehensive care approach in the routine management of HIV+ women
Presenting author: Fabio Russomano, Av das Americas 3555 bl 2 sala
302 Rio de Janeiro Brazil 22631-003, Brazil, Tel.: +55+21+25644933, Fax:
+55+21+25644933, E-mail: fabiorussomano@ montreal.com.br
ThPeC7550 Tuberculosis and AIDS in Espirito Santo State,
Brazil

S.F. Moreira-Silval, L.F. Pinto Neto2, A.P.N. Burian Lima3, A.L.A. Leite3,
D.O. Frauches3, S.S. Fernandes2, F.E.L. Pereira4. 1HINSG, SCMV, Rua Natalina
Daher Carneiro, 55/302, Jardim da Penha, Vitbria, Esp[rito Santo, 29060-490,
Brazil; 2SCMV Vitoria, Brazil; 3HINSG, Vitoria, Brazil; 4NDI-UFES, Vitoria,
Brazil
Background: Prevalence of tuberculosis (Tb) is increasing worldwide being HIV
infection the main predisposing factor. In Vitoria, ES, Brazil, there is increasing