Incidência da neoplasia intraepitelial cervical (nic) em uma coorte de mulheres infectadas pelo vírus da imunodeficiência humana (hiv)

Abstract

Introduction: The cervical cancer incidence in Brazil is still concern. The HIV/aids woman is considered of high risk of developing uterine cervix pre-cancer lesion and several factors of risk can contribute to the etiology of this tumor. Objectives: 1) To evaluate the cervical intraepithelial neoplasia (CIN) incidence diagnosed by histopathologic exam; 2) To identify risk factors for CIN; 3) To evaluate the human papillomavirus (HPV) prevalence, by using polymerase chain reaction assay (PCR); 4) To evaluate if the HPV-infected women at the admission of the study, have a high risk to develop CIN compared to the ones not infected by HPV. Methods: This is a nonconcurrent and concurrent prospective study with 348 HIV-positive women attended at Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias Orestes Diniz between 1997 and 2009. HPV detection was done at womens admission into the study using PCR and they were monitored during the follow-up with cytological and colposcopic exams and, when necessary, cervical biopsy until the presence of CIN be diagnosed by the histopathologic exam. Sociodemographic and behavioural variables were evaluated as well as HIV progression markers. The accumulated incidence of CIN and the person-years incidence were calculated. The CIN free time calculation was done by the Kaplan- Meier method to the HPV, age of the first sexual intercourse and antiretroviral variables. The Cox proportional hazard model was used in order to study the relation between each variable and CIN developing, and the evaluation of the independent effect of the variables on the CIN developing was done by the Cox multivariate model. The considered significance level was 0.05. Results: During the study period 13.5% of the women developed CIN. It was 4.1 cases per 100 person-years of followup. The HPV prevalence was 68.1%. The proportion of HPV-positive women at the admission of the study, that remained free of CIN during the follow-up was lower compared to HPV-negative women, however, the statistical association was not detected by the used criteria. The mean of CIN free time was lower to the women who had their first sexual intercourse at the age of 18 (or under) and among women who didnt use antiretroviral therapy or used it only during the pregnancy compared to the opposite group. The multivariate analyse showed that the women who had their first sexual intercourse at under or equal the age of 18 (RH=2.57; IC 95%=1.24-5.35) and the ones who never used antiretroviral therapy, or used it only during the pregnancy (RH=2.34; IC 95%=1.31-4.19) presented higher risk to develop CIN. Conclusions: The CIN incidence among this population was low and the HPV prevalence was high. The beginning of early sexual intercourse and the absence of treatment with antiretroviral therapy increased the risk of developing CIN. The HPV detection, of any type, didnt present risk to develop CIN. The result of this investigation showed that the cytological exam associated with the colposcopic rotine is a safe measure for the HIV-positive women follow-up.