Life Stress and Cervical Squamous Intraepithelial Lesions in Women With Human Papillomavirus and Human Immunodeficiency Virus

Objective: Human immunodeficiency virus (HIV)-infected women are at risk for cervical intraepithelial neoplasia (CIN) and cancer due to impaired immunosurveillance over human papillomavirus (HPV) infection. Life stress has been implicated in immune decrements in HIV-infected individuals and therefore may contribute to CIN progression over time. The purpose of this study was to determine whether life stress was associated with progression and/or persistence of squamous intraepithelial lesions (SIL), the cytologic diagnosis conferred by Papanicolaou smear, after 1-year follow-up among women co-infected with HIV and HPV. Method: Thirty-two HIV-infected African-American and Caribbean-American women underwent a psychosocial interview, blood draw, colposcopy, and HPV cervical swab at study entry. Using medical chart review, we then abstracted SIL diagnoses at study entry and after 1-year follow-up. Results: Hierarchical logistic regression analysis revealed that higher life stress increased the odds of developing progressive/persistent SIL over 1 year by approximately seven-fold after covarying relevant biological and behavioral control variables. Conclusions: These findings suggest that life stress may constitute an independent risk factor for SIL progression and/or persistence in HIV-infected women. Stress management interventions may decrease risk for SIL progression/persistence in women living with HIV. Key words: HIV, squamous intraepithelial lesions (SIL), human papillomavirus (HPV), stress, psychoneuroimmunology (PNI), women. AIDS acquired immune deficiency syndrome; CI confidence interval; CIN cervical intraepithelial neoplasia; HAART highly active antiretroviral therapy; HGSIL high-grade SIL; HIV human immunodeficiency virus; HPV human papillomavirus; LES Life Experiences Survey; LGSIL low-grade SIL; NKCC natural killer cell cytotoxicity; SIL squamous intraepithelial lesions.