[Frequency, persistence and recurrence of HPV lesions of the uterine cervix in HIV-seropositive women]

Abstract

Objective: The aim of this study was to determine the frequency, persistence and risk of recurrence of human papillomavirus (HPV) lesions of the uterine cervix in human immunodeficiency virus (HIV)-infected women.

Patients and methods: To determine the frequency of such lesions, we compared 148 HIV-positive patients with 4862 HIV-negative patients who had a cervical smear test in Toulouse university hospital. To determine the persistence and recurrence rate of the lesions, we prospectively followed 63 of the HIV-positive patients. Their follow-up was compared with that of 227 of the HIV-negative patients.

Results: Abnormal smears were much more frequent in HIV-positive patients (42 versus 5%, P<0.001). Persistence or aggravation of the lesions was also greater in HIV-positive patients (82 versus 43%, P<0.001). Lastly, the recurrence rate of dysplastic lesions after treatment was significantly higher in HIV-positive patients (64 versus 11%, P<0.001).

Discussion and conclusion: As the frequency, persistence and risk of recurrence of cervical HPV lesions are very high in HIV-positive women, close gynecological surveillance of these patients is indispensable. Surveillance must not be restricted to the uterine cervix because of the frequency of multifocal lesions: vagina, vulva, perineum and anus. It must also be adapted to the severity of immunodeficiency and the patient's history.