A incidência de neoplasia epitelial intracervical (NIC) e de infecção cervical pelo papilomavírus humano (HPV) em mulheres infectadas e não infectadas pelo vírus da imunodeficiência humana (HIV)

Abstract

Introduction: The incidence of cervical cancer is high in Brazil, and cervical infection with human papillomavirus (CI-HPV) is a necessary causal factor for its occurrence. HIV positive women are at higher risk for developing precancerous lesions and various other factors are involved in the genesis of this disease. Objectives: To perform a comparative study between two groups of women (HIV positive and negative) analyzing: prevalence and incidence of cervical intraepithelial neoplasia (CIN) and CI-HPV; viral risk and the relationship with the development of NIC; the sociodemographic and behavior parameters and that influenced the CI-HPV and the development of CIN. Methods: Cross sectional and prospective study analyzing 171 HIV-positive and 160 HIV negative women (examined during the period from October 2006 to February 2012). Im all visits were performed: cervical samples were assessed by polymerase chain reaction (PCR) to detect HPV DNA; colposcopy; pattern questionnaire to evaluate demographic and behavioral data; biopsy any colposcopic alterations. The histopathological examination was considered the gold standard for diagnosis of CIN. They had follow-up of at least one year. Results: HIV-positive women presented a higher prevalence of NIC (15.3 X 2.4%: p<0.001), and CI-HPV infection (55.5 X 37.1%: p-0.002), and CI-HPV of high risk (35.7 X 23.6%: p=0.021). HPV 16 was the predominant type in total and in women who had NIC in both groups. NIC incidence was 8.8 and 4.6 persons for 100 women/year (HIV positive/HIV negative women). HIV positive women developed NIC in a lower interval of time (10% developed NIC in 0.86 X 2.03 years: p=0.013). Protection factors for the development of NIC were age (RR 0.95: IC 95% 0.91-0.98 for each year of life) and civil status (RR 0.41: IC 95% 0.18-0.91: stable union-married-widow). and the risk factor for CIN was the presence of HIV infection (RR 2.89: IC 95% 1.27-6.55). Incidence of CI-HPV was 18.1 and 11,4 persons for 100 women/year (HIV positive and negative women). HIV positive women developed CI-HPV in a lower interval of time (median time of 1.65 X 2.6 years: p=0.002), and those who presented HPV had a higher risk of CIN (47.6 X 10,5%: p=0,015). Protection factors for the development of CI-HPV was age ((RR 0.82: IC 95% 0.73-0.93 for each year after the first sexual intercourse) and the risk factor was the presence of HIV infection (RR 2.12: IC 95% 1.02-4.93). HPV 16 was the type of higher cumulative incidence (9.2 e 5.9%) and the more related to the development of NIC in both groups (23.1 and 11.1%). Conclusions: HIV positive women had higher prevalence of NIC and CI-HPV. They also presented a higher risk of developing NIC and CI-HPV. HPV 16 was the predominant type, presenting with the highest incidence and prevalence in both groups, and it was also the high risk HPV type more frequent among women that had NIC. Older women had low risk for the development of NIC and CI-HPV, and those with stable union had lower risk for NIC.