[Intraepithelial cervical carcinoma and HIV. Prevalence, risk factors and prevention strategies].

Background The present study analyses cervical dysplastic lesions associated with HIV infection by means of cytological, colposcopic and histologic examinations, and the diagnostic accuracy of the Pap test. Methods. Cross-sectional study. We have studied colposcopic and histologic findings of 115 HIV-positive women. In 86 patients a cytological examination was also carried out. The results were compared with those of a control group consisting of 127 HIV-negative women in pre-menopause age. Results. The prevalence of cervical dysplastic lesions present at colposcopic/bioptic examination was 3.2 times greater in HIV+ women than in HIV- women (38% vs 12%, p<0.001) and that of_lesions of a higher degree 7 times greater. Compared to non-HIV+ women, patients who were positive presented more severe dysplastic lesions, a higher frequency of HPV-derived lesions and inflammatory pictures. There was also a correlation between high incidence of dysplastic cervical lesions and advanced stage of immunodepression. The negative predictive value of the Pap test was higher in the seronegatives (95%) than in the seropositives (83%, p<0.01). The overall agreement between cytology and colposcopy/histology was greater in the seronegatives than in the seropositives (87% vs 74%, pPap test in association with HIV is reduced. These results suggest that in HIV+ patients careful combined cytological-colposcopic screening should be adopted, together with an attentive cyto-colposcopic follow-up in treated patients.