Universidade Federal do Rio Grande do Sul Faculdade de Medicina Programa de Pós-Graduação em Medicina: Ciências Médicas Prevalência, Incidência, Progressão e Regressão das Lesões Intra-epiteliais do colo uterino de Mulheres Portadoras do HIV

Objective: To evaluate the impact of HIV immune depletion, highly active antiretroviral therapy (HAART) and patient characteristics on the occurrence of squamous intraepithelial lesions (SIL) and cervical cancer. Design: Cohort study Population: From July 1997 to April 2007, 898 HIV-positive women were evaluated at the time of their first Pap smear in the clinic; 388 women received additional Pap smears during follow-up visits. Methods: Prevalence and incidence of SIL in Pap smears were studied. Progression and regression were evaluated in follow-up of patients presenting low-grade SIL. Pap smears collected at baseline were recommended to be repeated yearly if negative. Women with high-grade or persistent low-grade SIL were referred for colposcopy and biopsy. Results: 898 women were enrolled with one available Pap smear; 388 (43%) received at least one additional Pap smear during follow-up (maximum 8 Pap tests). Patient characteristics at baseline were white skin (68.7%), age (mean=32 years, range=13 to 79 years), completed years in school (median=7), CD4 count (median=419 cells/mm3), viral load (median=1,645 copies/mL), and treatment status (38% on HAART). Pap smear results at baseline were: 741 normal (82.5%), 56 atypical squamous cells of indeterminate significance (ASCUS) (6.2%), 78 low-grade SIL (8.7%), 22 high-grade SIL (2.4%) and 1 invasive cervical cancer (0.1%). The SIL cumulative incidence rate was 9.7%. Progression and regression occurred in 15.9% and 62%, respectively, of women presenting with low-grade SIL. Progression was more frequent when a reduction in CD4 count was observed during follow-up (P=0.01). Multivariate analysis of CD4 counts ≤ 200 cells/mm3 (aHR=2.1; 95% CI: 1.33.5; P=0.004) and age less than 30 years (aHR=3.2; 95% CI: 1.5-6.8; P=0.01) or less than 40 years old