Cervical Cytology and Histopathologic Abnormalities in Women living with AIDS in Sao Paulo, Brazil

Background: Women living with HIV/AIDS present with a higher prevalence of human papillomavirus (HPV) infection, higher rates of squamous intraepithelial lesions, and are more susceptible to invasive cervical carcinoma progression. Objective: We assessed the frequency of precursory cervical lesions of cancer and its risk factors for women living with HIV/AIDS. Methods: Sociodemographic, clinical, behavioral, and laboratory data were collected from medical records from 2008 to 2009 and analyzed using forward stepwise logistic regression. Results: Medical records of 631 women were reviewed; mean age at AIDS diagnosis was 34 years old (interquartile range = 29-40 years old), 32% were <16 years old at first sexual intercourse; 61% had <= 5 sexual partners during life; 43% had been living with AIDS for >9 years; 47% reported previous sexually transmitted infections; 44% presented with HPV infection; and 10% presented with high squamous intraepithelial lesions. Presenting high squamous intraepithelial lesions was significantly associated with home district Human Development Index, age at AIDS diagnosis (>40 years old), time of AIDS diagnosis (>8 years), CD4(+) cell count <350/mm(3), and HPV infection. Conclusions: Frequent squamous intraepithelial neoplasia in these women shows the importance of gynecologic examinations in routine care and follow-up required by those who present with cervical lesions.