Expressão de citocinas no estroma cervical de mulheres infectadas e não infectadas pelo Vírus da Imunodeficiência Humana (HIV) com Neoplasia Intraepitelial Cervical (NIC)

Abstract

Objective: To investigate whether there are differences in the immune response by means of a immunohistochemical analysis of cytokines expression (IL-4, IL-12, IFN- and TGF-) in the cervical stroma of women with CIN lesions, both HIVinfected and HIV non-infected. The secondary objective is to investigate whether there are differences in the local immune response between high and low grade CINs. Methods: This was a cross-sectional study which analyzed cone specimens of CIN lesions in both HIV-infected and HIV non-infected women. Conization by loop electrosurgical excision procedure was performed from January 1999 to May 2004. An immunohistochemical analysis was conducted to assess cytokine expression. The chi-square test was used to compare categorical variables and the U-Mann-Whitney and chi-square were used to test for associations, with p= 0.05. The multivariate analysis was done using logistic regression. In multiple regressions for HIV and lesion grade, the potential predictors for the univariate analysis were selected with a level of significance of 0.20. Hosmer-Lemeshow test was chosen to test for the goodness of fit for logistic regression. Results: In relation to HIV status, no differences were found in the local immunity when HIVinfected and HIV non-infected women were compared. However, when the interaction between HIV and CIN grade was evaluated, there was a significant association of IL-2 expression in HIV-infected women and with high grade CIN (P=0,016) and association of IL-4 (0,0456) in HIV-infected women and with low grade CIN. As for lesion grade, there was an association between TGF- and high grade CIN in both HIV-infected and HIV non-infected women (P=0,000). Conclusion: There seems to be an interaction between HIV and CIN grade since a change in the expression of IL-12 and IL-4 in HIV infection was found. As far aslesion grade is concerned, there is a prevalence of TGF- in high grade CIN, possibly reflecting the prevalence of an immunoregulatory environment.