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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Increased risk for cervical intraepithelial neoplasia (CIN) in human immunodeficiency virus (HIV)-infected women may be explained by repeated positivity of human papillomavirus (HPV) infection facilitated by HIV infection and related immunosuppression. As part of a longitudinal study with semiannual examinations, 268 women in Baltimore, Maryland (of whom 184 were HIV+), provided 1,426 cervicovaginal lavage specimens tested for HPV DNA by a polymerase chain reaction-based assay between 1992 and 1998. HPV positivity and time to HPV clearance according to HIV serostatus and CD4+ cell count were compared using models for correlated binary data and survival analysis. Of the 187 participants who had at least one positive measurement, the probability of subsequent HPV positivity among HIV- women and HIV+ women with CD4+ > or =200 and <200 cells/microl was 47.5%, 78.7%, and 92.9% (p < 0.001). Within-women HPV results were correlated (i.e., clustered) in each group (p < 0.01). Compared with HIV-participants, the relative incidence of HPV clearance was 0.29 and 0.10 among HIV+ women with CD4+ > or =200 and <200 cells/microl (p < 0.001). At the end of follow-up, 11 women had biopsy-confirmed CIN. The association of HIV and CIN (p = 0.014) was fully explained by repeated HPV positivity induced by HIV infection (p = 0.648). Reversal of immunosuppression following potent antiretroviral therapy must be expected to have a dramatic impact on HIV-related CIN.
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PMID:Cervical neoplasia and repeated positivity of human papillomavirus infection in human immunodeficiency virus-seropositive and -seronegative women. 1090 27

Cervical intraepithelial neoplasia (CIN) is common in patients positive for human immunodeficiency virus (HIV). The questions are whether the management of CIN in these patients should be different from that of HIV-negative women, whether there are any prognostic factors to indicate the course of CIN, and whether the latter is influenced by antiretroviral therapy. A total of 267 HIV-seropositive women were counseled and examined in our colposcopic clinic. Of that number, 53 patients died during the observation period; 74% of these patients were immunosuppressed (CD4 count < 200 cells/mm3), and 45% were given diagnoses of CIN. The incidence of CIN was significantly higher in patients with CD4 less than 200 cells/mm3. Neither the route of HIV infection nor the HPV status nor smoking habits correlated with CIN. CIN relapse was histologically confirmed in 28% of patients who underwent complete surgical removal. Immune status plays an important role in HIV-positive women not only with respect to survival but with respect to CIN.
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PMID:Cervical intraepithelial neoplasia in human immunodeficiency virus-positive patients. 1091 40

Bacterial vaginosis is characterized by a shift from the predominant lactobacillus vaginal flora to an overgrowth of anaerobic bacteria. Bacterial vaginosis is associated with an increased risk of gynecologic complications, including pelvic inflammatory disease, postoperative infection, cervicitis, human immunodeficiency virus (HIV), and possibly cervical intraepithelial neoplasia (CIN). The obstetrical risks associated with bacterial vaginosis include premature rupture of membranes, preterm labor and delivery, chorioamnionitis and postpartum endometritis. Despite the health risks associated with bacterial vaginosis and its high prevalence in women of childbearing age, bacterial vaginosis continues to be largely ignored by clinicians, particularly in asymptomatic women.
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PMID:Gynecologic conditions and bacterial vaginosis: implications for the non-pregnant patient. 1096 4

The objective of the study was to assess the prevalence of underlying cervical and endometrial lesions among patients with atypical glandular cells of undetermined significance (AGCUS) on the cytologic smear. Eighty-six patients with AGCUS, without evidence of squamous intraepithelial lesions, underwent coloposcopy and endocervical curettage (ECC) within 6 months of the initial finding. Endometrial samplings were performed in 25 patients. Coloposcopy, endocervical curettage, and endometrial biopsy results were reviewed. A significant lesion was defined as cervical intraepithelial neoplasia and/or any structural or histologic abnormality of the cervix or uterus (i.e., polyp). Statistical analyses were performed using the t test, chi-square, and Fisher's Exact tests comparing patients with underlying lesions to those without. A significant lesion(s) was identified in 21 (24.4%) patients, with 8 (9.3%) of the lesions being high-grade cervical neoplasias. An additional 14 (16.3%) patients, with negative initial work-ups, had underlying lesions or major cytologic abnormalities diagnosed on subsequent follow-up. All of the endometrial findings were benign. None of the following were statistically significant predictors of underlying pathology: age, gravidy, parity, medications, medical history, tobacco use, history of sexually transmitted diseases including human immunodeficiency virus, previous abnormal cytologic smear, concurrent diagnosis of atypical squamous cells of undetermined significance, or evidence of human papillomavirus. AGCUS is often associated with clinically important underlying lesions. Patients should therefore undergo colposcopy and ECC. Endometrial sampling and possible cervical conization should be performed when coloposcopic evaluation is nondiagnostic.
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PMID:The clinical importance of atypical glandular cells of undetermined significance on the cytologic smear. 1107 38

Sub-Saharan Africa is considered home to more than 60% of all human immunodeficiency virus (HIV) infected cases, with an estimated adult prevalence of 8.0%. It is stated that this region has contributed more than 90% of childhood deaths related to HIV infection and about 93% of childhood acquired immunodeficiency syndrome (AIDS)-related deaths. Although no country in Africa is spared of the infection, the bulk is seen in East and South Africa, with the highest recorded rates of 20% to 50% in Zimbabwe. On the other hand, West Africa is less affected, while countries in Central Africa have relatively stable infection rates. Although infections, especially tuberculosis, have emerged as the most important HIV/AIDS-associated killers in recent times, AIDS-associated malignancies are increasingly identified in the late stages. As a result of incomplete data from African countries, it is unclear whether the epidemiology and risks of these cancers are the same as observed in the developed countries. Since the advent of AIDS, epidemic Kaposi's sarcoma (KS) has become more common in both sexes in Africa, with a dramatic lowering of the male to female ratio from 19:1 to 1.7:1, especially in East Africa. Although there has been a rising trend of AIDS-associated non-Hodgkin's lymphoma (NHL) worldwide, there is an apparently lower risk in Africa compared with that in the developing world. At present, there is no strong evidence linking increased incidence of invasive cervical cancer to the HIV epidemic; however, some studies have demonstrated an association between HIV and the increased prevalence of human papilloma virus (HPV) and cervical intraepithelial neoplasia (CIN). On the other hand, HIV infection is now established as a risk factor for the development of squamous cell neoplasia of the conjunctiva based on studies from Rwanda, Malawi, and Uganda. Despite the problems and limitations of information from sub-Saharan Africa, interesting trends of HIV/AIDS-related cancers have emerged from comparison of available data. Semin Oncol 28:198-206.
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PMID:Acquired immunodeficiency syndrome-associated cancers in Sub-Saharan Africa. 1130 83

The hypothesis tested was that there is an association between the presence of proliferating (MiB-1-positive) cervical cells and clinical outcome of women infected with human immunodeficiency virus (HIV). Female partners (attending the Gynecology Outpatients Clinic of the University Hospital of Rio Grande, Brazil) of known HIV-positive (HIV+) men were used for this pilot study. Among these women, 25 were also HIV+. Papanicolaou smears of these 25 HIV+ women and of 44 HIV- women were graded as negative, CIN I, CIN II, or CIN III, using neural network screening. MiB-1 grading and HPV identification were also performed. The immune status of patients was determined using the current Centers for Disease Control classification. In agreement with the scientific literature, in these Brazilian women both CIN and HPV were associated with HIV. In the HIV+ women, the immune status tends to correlate with MiB-1 grading. Also, in the one case in whom progression from CIN I to invasive cervical carcinoma was observed, the smear contained many MiB-1-positive cells. Staining cervical smears of HIV+ women is a simple procedure to get an indication of clinical outcome of the patient.
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PMID:Presence of proliferating (MiB-1-positive) cells in cervical smears of women infected with HIV is associated with clinical outcome: a study of Brazilian women. 1139 16

Cytomegalovirus (CMV) can cause life-threatening disease in immunocompromised patients, such as those with human immunodeficiency virus (HIV). It is a rare but important cause of ulceration in the female genital tract. We report on three cases of CMV disease in the female genital tract. One patient presented with vulvar ulceration and fevers, and two patients presented with bleeding cervical lesions. All diagnoses were confirmed by histology. All patients were treated with intravenous ganciclovir with good result. CMV disease of the female genital tract may result in significant morbidity, with fever, pain, bleeding, and superinfection, and it may be associated with the development of pelvic inflammatory disease and cervical intraepithelial neoplasia. There are several options for diagnosis and for safe treatment.
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PMID:Cytomegalovirus disease in the lower female genital tract. 1158 31

The cause of acquired immunodeficiency syndrome (AIDS), the human immunodeficiency virus (HIV), has been identified by 2 types: HIV 1 and HIV 2. Detection is done through blood testing and is difficult to diagnosis by symptoms because the disease has a latency period. 28 countries in Europe and the surrounding Mediterranean area reported a total of 10,181 cases of AIDS by December 31, 1987. The largest percentage of cases are in the sexually active category, and the number of cases among heterosexuals is growing rapidly. Family planning staff are in the position to provide information about disease transmission and AIDS prevention. Concerning AIDS testing, information that details the benefits and problems of testing and diagnoses should be discussed. Patients who test positively should be counselled and given follow-up examinations. "Safer sex" is identified as sexual interaction without fluid interchange. For those who chose to have vaginal intercourse, methods such as condoms and spermicides should be used to minimize risk. The use of these methods should be emphasized if 1 in a partnership is infected or if the individual is sexually active. Condoms and spermicides are the most effective methods as oral contraceptives have no preventive abilities and the IUD has proven to exacerbate the spread of disease. Women at risk should understand that there is a 30-50% chance of passing the disease on in pregnancy to a fetus and that HIV infection increases the risk of hepatitis B and cervical intraepithelial neoplasia (CIN).
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PMID:Epidemiological and preventive aspects of HIV infection. 1222 7

The goal of this review is to summarize recently published epidemiological information that contribute to understanding the natural history of cervical and human papillomavirus (HPV) infection and their associated lesions among human immunodeficiency virus (HIV) infected women and men. HIV-positive women and men are more likely to be infected with oncogenic HPV types and to have cervical intraepithelial neoplasia (CIN) or anal intraepithelial neoplasia (AIN), lesions that may lead to invasive cervical and anal cancer, respectively. Although the magnitude of the increased risk of cervical or anal cancer in HIV-positive individuals is not clear, it is clear that the risk will remain elevated even in the HAART era. Full screening for CIN remains necessary in HIV-positive women and it is likely that screening for AIN will be beneficial as well to prevent invasive anogenital cancer in long-term AIDS survivors.
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PMID:Cervical and anal HPV infections in HIV positive women and men. 1244 60

This review describes three cases of human immunodeficiency virus-infected women who were diagnosed with vulvar cancer before age 40 years. A retrospective chart review was performed for three patients who were younger than 40 years of age and who had histologically confirmed invasive squamous cell carcinoma of the vulva diagnosed between 1999 and 2002. Demographic, clinical, and laboratory data were recorded. Three human immunodeficiency virus-seropositive women were diagnosed with invasive squamous cell carcinoma of the vulva, stages IA, IB1, and III. All cases were characterized by extensive surrounding vulvar, vaginal, and cervical intraepithelial neoplasia. CD4 cell counts were 250, 330, and 900 cells/uL. Two patients experienced previous acquired immune deficiency syndrome-defining illnesses: toxoplasmosis and cervical cancer. Vulvar cancer in young human immunodeficiency virus-seropositive women may be associated with other human papillomavirus-related diseases and immunosuppression, as evidenced by low CD4 counts and the presence of antecedent acquired immune deficiency syndrome-defining illnesses.
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PMID:Vulvar cancer in human immunodeficiency virus-seropositive premenopausal women: a case series and review of the literature. 1587 May 15


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