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Women are an increasing proportion of the HIV-infected population. In addition, compared with their HIV-negative counterparts, they have a greater incidence of both cervical intraepithelial neoplasia (CIN) and invasive cervical cancer, which tends to be more progressive and aggressive. The development of invasive cervical carcinoma in an HIV-infected woman is an AIDS-defining diagnosis. However, what is not clear is whether women who are identified with cervical carcinoma should be offered screening for HIV infection. This review addresses these issues and provides a cost-effectiveness assessment.
Int J STD AIDS 2001 May
PMID:HIV in cervical cancer. 1136 99

Human papillomavirus (HPV) infections and HPV-associated penile lesions are frequently found in male sexual partners of women with cervical intraepithelial neoplasia (CIN). To determine the significance of these findings, we studied the prevalence of HPV and HPV associated penile lesions in a male hospital population with non-STD complaints. Penoscopy was performed after application of acetic acid to identify flat lesions, papular lesions, condylomata acuminata and pearly penile papules (PPPs). Presence of HPV DNA in penile scrapes was tested by GP5+6+ PCR. In case of HPV 16 positivity, viral loads were quantified using a LightCycler based real-time PCR method. Comparing the non-STD male hospital population (n = 118) with the male sexual partners of women with CIN (n = 238), flat penile lesions were found in 14% vs. 60% and penile HPV in 25% vs. 59% of the men, respectively. We found that the presence of penile HPV and, in case of HPV 16 positivity, higher viral loads were associated with the presence of flat penile lesions. Amongst the HPV-positive men, flat penile lesions were more common and larger in size in male sexual partners of women with CIN than in the non-STD hospital population. HPV infections and HPV-associated flat penile lesions are commonly found in the non-STD male population. However, these lesions are less frequently present and smaller in size than in male sexual partners of women with CIN. Higher viral loads in penile scrapes of male sexual partners of women with CIN are reflected by a higher prevalence of flat penile lesions and a larger size of these lesions.
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PMID:HPV-associated flat penile lesions in men of a non-STD hospital population: less frequent and smaller in size than in male sexual partners of women with CIN. 1538 60

The objective of this study was to assess the available evidence on the outcome of cervical intraepithelial neoplasia (CIN) in HIV-positive women after conization. We performed a literature search of Medline and Cochrane libraries to locate published articles reporting about the rate of recurrence of CIN after excisional treatment in patients with negative surgical margins. Out of 15 articles, five studies reported recurrence rate of CIN in margin negative patients. The recurrence rate of CIN after conization in HIV-infected women ranges from 20% to 75%. No conclusions can be drawn about the impact of CD4 cell counts on the recurrence rate. Available evidence suggests that standard excisional treatments for CIN are associated with high rates of recurrence in HIV-positive women. Despite the fact that the evidence is limited because of the few number of eligible studies, this issue should be considered in the management of HIV-positive patient with CIN.
Int J STD AIDS 2006 Aug
PMID:The recurrence of cervical intraepithelial neoplasia in HIV-positive women: a review of the literature. 1692 93

Data are controversial as to the role of menarche age as a risk factor of high-risk human papillomavirus (HR-HPV) infections. The objective of this study was to analyse the risk estimates for age at menarche as determinant of cervical intraepithelial neoplasia (CIN) and HR-HPV infections. A cohort of 3187 women were stratified into three groups according to their age at menarche: (i) women <13 years of age; (ii) those between 13 and 14 years and (iii) women >15 years of age. These groups were analysed for predictors of (a) HR-HPV, (b) high-grade CIN and (c) outcome of HR-HPV and cytological abnormalities during prospective follow-up. All the three groups had identical prevalence of HR-HPV, Papanicolaou smear abnormalities and CIN grades. In contrast to menarche age itself, the time from menarche to the first intercourse (TMI), to the first pregnancy (TMP) and to the first delivery (TMD) were all significant (P = 0.0001) predictors of HR-HPV (but not CIN2) in univariate analysis, but lost their significance in a multivariate model. Outcome of cervical disease and HR-HPV infection was unrelated to menarche age, the latter and the three intervals being not predictors of CIN2 in a multivariate model. In conclusion, age at menarche and the intervals between menarche and (i) onset of sexual activity, (ii) first pregnancy and iii) first delivery, are not independent predictors of HR-HPV infections and CIN2 in multivariate analysis.
Int J STD AIDS 2008 Jan
PMID:Age at menarche is not an independent risk factor for high-risk human papillomavirus infections and cervical intraepithelial neoplasia. 1827 41

The prevalence of cervical intraepithelial neoplasia (CIN) is high among HIV-infected women. Decreased CD4 lymphocytes, high human immunodeficiency viral load (HIVL) and human papillomavirus (HPV) infection are risk factors for CIN. We characterized the prevalence, risk factors and prognosis of histologically-verified CIN among systematically followed HIV-infected women enrolled from a low HIV-prevalence population. The study population comprised 153 HIV-infected women followed between 1989 and 2006. The mean +/- SD duration of follow-up was 5.6 +/- 3.8 years. Demographic as well as treatment-related data were derived from medical reports. During the follow-up, 51 subjects (33%) displayed CIN (16% CIN 1 and 18% CIN 2 +), whereas 102 subjects had Pap smear results of normal cells, atypical squamous cells of uncertain significance, or signs of low-grade squamous intraepithelial lesion (LSIL) but no CIN in histological specimens from the cervix. Only one case of cancer of the uterine cervix was detected. Pap smears were reliable in screening for CIN; 75% of patients with CIN had high-grade squamous intraepithelial lesion (HSIL) or LSIL in Pap smears taken at the time of dysplasia. The incidence of CIN decreased from 12.7 to 3.5 (per 100 subjects) between 2000 and 2005 (P = 0.07). The risk of CIN was not associated with decreased levels of CD4 lymphocytes, duration of HIV infection, use of antiretroviral medication or plasma HIVL. In univariate analysis, bacterial vaginosis (BV) was associated with a significantly increased risk of CIN, whereas parity was associated with lower risk of CIN. Each delivery lowered the risk of CIN by 30% (P = 0.02). The significantly lower risk of CIN among parous women (P = 0.04) persisted in multivariate analysis. CIN was treated by means of loop electrosurgical excision procedure (LEEP), (n = 34). The recurrence rate was low; seven subjects (14%) had a recurrence of CIN during follow-up. The nadir of CD4 lymphocytes was lower (P = 0.04) and the HIVL higher (P = 0.03) among subjects with recurrence of CIN. Duration of HIV infection, use of antiretroviral medication and positive margins in LEEP specimens were indistinguishable among subjects with vs. without recurrence of CIN. The prevalence of CIN is high among systematically managed HIV-infected women. However, the incidence of CIN decreased during the 21st century. BV was associated with an increased risk of CIN whereas parous women had lower risk of CIN. However, the patients with and without CIN could not be distinguished on the basis of previously described risk factors. Regular follow-up by means of Pap smears is warranted in all HIV-infected women.
Int J STD AIDS 2008 Jan
PMID:Risk factors, diagnosis and prognosis of cervical intraepithelial neoplasia among HIV-infected women. 1827 45

The main objective of this study was to assess the feasibility of human papillomavirus (HPV) genotyping in women referred for colposcopy due to abnormal Papanicolaou (Pap) smear. A series of 248 women referred for colposcopy due to an abnormal Pap smear were analysed with the Roche Linear Array HPV genotyping test detecting 37 most frequent HPV types, and compared with hybrid capture II (HCII) assay for oncogenic (high-risk [HR] HPV) types as well as for p16INK4a expression using immunocytochemistry. All tests were performed in cervical samples collected in PreservCyt liquid media for liquid-based cytology (ThinPrep), and colposcopic biopsy and/or loop electro excision procedure cone biopsy was used as the gold standard. HPV16 was the single most frequent genotype (29/258; 11.7%), followed by HPV51 (4.4%), HPV66 (3.6%), HPV42, 52 and 56 (3.2% for all). Linear array genotyping test significantly predicts both abnormal colposcopy (odds ratio [OR] = 9.0; 3.12-25.93), high-grade squamous intraepithelial lesions (OR = 9.6; 1.26-74.17) and cervical intraepithelial neoplasia (CIN) 3+ (OR = 29.3; 3.95-218.06). In detecting CIN3, linear array was equivalent (97.6%) to colposcopy in sensitivity (SE), both being superior to HCII (92.7%). Concordance between linear array and HCII was moderate (Cohen's kappa kappa = 0.547; 95% confidence interval [CI]: 0.435-659). Specificity (SP) and positive predictive value (PPV) of linear array were significantly improved, if only HPV16 genotype was considered. Performance in the best balance is obtained, when linear array and colposcopy are combined, giving 82.9% SE, 93.9% SP, 73.9% PPV and 96.3% negative predictive value (NPV) as predictor of CIN3+ (OR 74.5; 95% CI: 27.36-202.72). In conclusion, linear array for HR-HPV is a highly sensitive test (97.6%) with high NPV (98.9%) in detecting CIN3+ lesions. HPV16 genotyping alone significantly improves SP and PPV of this test in management of women with abnormal cytology.
Int J STD AIDS 2008 Jun
PMID:Linear array genotyping and hybrid capture II assay in detecting human papillomavirus genotypes in women referred for colposcopy due to abnormal Papanicolaou smear. 1859 76

The aim of the study was to evaluate the frequency of human papillomavirus (HPV) 16 and 18 infections in patients with cervical intraepithelial neoplasia (CIN) according to the use of various contraceptive methods. In a study group of 1435 patients with histologically proven CIN, among whom 391 (27.2%) used no contraception, 44 (3.1%) used barrier methods, 705 (49.1%) used oral contraceptives and 295 (20.7%) used an intrauterine device (IUD), the presence of HPV infection was evaluated by DNA in situ hybridization. HPV 16 or 18 infection was present in 666 (46.4%) of all patients in 348 (49.4%) patients who used oral contraceptives, in 169 (43.2%) patients with no contraception, in 128 (43.4%) patients with an IUD and in 21 (47.7%) patients who used barrier methods. There were no significant differences in HPV 16 and 18 infection frequencies among all four groups of patients regarding the contraception method used.
Int J STD AIDS 2010 Jun
PMID:Use of various contraceptives and human papillomavirus 16 and 18 infections in women with cervical intraepithelial neoplasia. 2060 23

Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the USA, and has major physical and psychological consequences including fear, anxiety and stigma. To date, there is no measure of health-related quality of life specifically designed to assess symptoms and functioning for people with cervical dysplasia resulting from HPV infection. In the present study, we set out to develop a disease-specific measure of health-related quality of life among women with low-grade cervical dysplasia. We conducted literature reviews, open-ended interviews with patients, clinician surveys and cognitive interviews which guided item development. The result is a preliminary 36-item measure, the Functional Assessment of Chronic Illness Therapy-Cervical Dysplasia (FACIT-CD), which sets out to assess the physical and psychological health-related quality-of-life aspects of cervical dysplasia and will be validated in an upcoming study.
Int J STD AIDS 2010 Oct
PMID:Developing a measure of health-related quality of life for women with cervical dysplasia resulting from human papillomavirus infection. 2113 48

The objective of this study is to audit the implementation and knowledge of the British HIV Association (BHIVA) UK National guidelines for HIV testing (2008) in key conditions at Basildon & Thurrock University Hospital. Basildon Hospital is a district general hospital, serving over 400,000 patients in south-west Essex. A total of 348 patients were assessed through electronic to pathology data and patients' notes to investigate if they had been tested for HIV when diagnosed with the following conditions: tuberculosis (TB), hepatitis B and C, cervical intraepithelial neoplasia grade II/III, lymphoma, anal cancer, seminoma or Castleman's disease. The physicians involved were questioned as to their knowledge of the HIV testing guidelines. Of the 348 patients who were identified as having the above mentioned conditions, only 13.8% of those with any of the key conditions had received an HIV test. Only one non-HIV physician was aware of the guidelines. Knowledge of the 2008 BHIVA HIV testing guidelines is scanty among non-HIV-trained physicians. Health-care professionals in the field, irrespective of their role, should work harder to disseminate information and reduce prejudice that decreases testing of at-risk individuals.
Int J STD AIDS 2011 Feb
PMID:Assessment of the implementation and knowledge of the UK National Guidelines for HIV Testing (2008) in key conditions at a UK district general hospital. 2142 32

In addition to oncogenic 'high-risk' human papillomaviruses (HR-HPV), several co-factors are needed in cervical carcinogenesis, but it is poorly understood whether these HPV co-factors associated with incident cervical intraepithelial neoplasia (CIN) grade 1 are different from those required for progression to CIN2 and CIN3. To gain further insights into the true biological differences between CIN1, CIN2 and CIN3, we assessed HPV co-factors increasing the risk of incident CIN1, CIN2 and CIN3. Data from the New Independent States of the Former Soviet Union (NIS) Cohort (n = 3187) and the Latin American Screening (LAMS) Study (n = 12,114) were combined, and co-factors associated with progression to CIN1, CIN2 and CIN3 were analysed using multinomial logistic regression models with all covariates recorded at baseline. HR-HPV-positive women (n = 1105) represented a subcohort of all 1865 women prospectively followed up in both studies. Altogether, 90 (4.8%), 39 (2.1%) and 14 (1.4%) cases progressed to CIN1, CIN2 and CIN3, respectively. Baseline HR-HPV was the single most powerful predictor of incident CIN1, CIN2 and CIN3. When controlled for residual HPV confounding by analysing HR-HPV-positive women only, the risk profiles of incident CIN1, CIN2 and CIN3 were unique. Completely different HPV co-factors were associated with progression to CIN1, CIN2 and CIN3 in univariate and multivariate analyses, irrespective of whether non-progression, CIN1 or CIN2 was used as the reference outcome. HPV co-factors associated with progression to CIN1, CIN2 and CIN3 display unique profiles, implicating genuine biological differences between the three CIN grades, which prompts us to re-visit the concept of combining CIN2 with CIN3 or CIN1.
Int J STD AIDS 2011 May
PMID:Co-factors of high-risk human papillomavirus infections display unique profiles in incident CIN1, CIN2 and CIN3. 2157 74


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