Terms and viruses

Studies performed in the early 1990s suggested that HIV-positive women were more likely to develop cervical dysplasia than HIV-negative women. A group of abnormal cells is called a lesion. Cervical dysplasia lesions can shrink or disappear, persist or progress to become cervical cancer. Cervical dysplasia has been linked to a common virus called HPV (human papilloma virus). There are over 70 strains of HPV, some cause warts, including genital warts, while others can cause cancer.

Researchers in New York city conducted a five-year study on 653 women to find out how many developed abnormal growths on their cervix.

Study details

Researchers recruited 328 HIV-positive women and 325 HIV-negative women for this study. The HIV-positive women had an average CD4+ count of 429 at the start of the study. Viral load was not measured during the study. At the start of the study all women underwent the following procedures:

• A Pap smear
• Testing for HPV
• Microscopic examination of the cervix (colposcopy)

The following tests were performed at regular intervals during the study;

• Pelvic exam
• Pap smear
• HPV testing

Women with abnormal Pap smear results had their cervix examined for growths. When necessary, the growths were removed for analysis. On average, HIV-positive women remained in the study for about 2.5 years and HIV-negative women, just slightly longer. Seventy percent of women returned at least four times for their appointments. Since the study took place between 1991 and 1996, none of the women used protease inhibitors.

Results-cervical dysplasia

Within these two groups the following percentages of women developed abnormal growths on the cervix during the study:

• HIV-positive women - 20%
• HIV-negative women - 5%

Results-Biopsy

Samples of abnormal growths in women with cervical dysplasia were analysed. Among women with HIV, the following results were observed:

• 91% of the samples had mildly abnormal cells.
• 9% samples were described as presenting moderate dysplasia, meaning that about two thirds of the cells were abnormal and pre-cancerous.

HIV-positive women were just as likely to develop moderate dysplasia as HIV-negative women. Doctors did not find any cases of cervical cancer during the study.

Results- risk of cervical dysplasia

After analysing their data, the study authors arrived at the following conclusions:

• HIV-positive women were five times more likely to develop cervical dysplasia thant HIV-negative women.
• Women with detectable HPV were more likely to develop cervical dysplasia than women who did not have this virus.

Researchers in this study found fewer cases of dysplasia than in other studies. This probably occurred because the women had undergone colposcopic exams, which probably helped avoid the misclassification of growths.

Results may be different in HIV-positive women who are not screened for cervical dysplasia on a regular basis. The reasons for the increased risk of dysplasia in HIV-positive women are as follows:

• Possible increased risk of exposure to HPV
• Weakened immunity for controlling HPV infection due to HIV/AIDS

REFERENCES

1. Ellerbrock TV, Chaisson MA, Bush TJ, et al. Incidence of cervical squamous intraepithelial lesions in HIV-infected women. Journal of the American Medical Association 2000;283:1031-1037.

2. Petter A, Heim K, Guger M, et al. Specific serum IgG IgM and IgA antibodies in human papillomavirus types 6, 11, 16, 18 and 31 virus-like particles in human immunodeficiency virus-seropositive women. Journal of General Virology 2000;81:701-708.

3. Lowy DR and Schiller JT. Papillomaviruses and cervical cancer: pathogenesis and vaccine development. Journal of the National Cancer Institute Monographs 1998;23:27-30.

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