Study of cervical cytological changes in hiv patients

Abstract

TITLE: STUDY OF CERVICAL CYTOLOGICAL CHANGES IN HIV PATIENTS Authors: Dr Mirza Asif Baig1 , Dr Anil K. Sirasgi 2 INTRODUCTION HIV is one of the most dreaded infections today. Ever since the first HIV case in India was detected in sex workers in Chennai, Tamil Nadu; in 19861, the number of people living with HIV has risen to 2.31 million people. In Karnataka, a state with a population of around 53 million, HIV prevalence among ante-natal clinic attendees exceeded 1% from 2003 to 2006 and dropped to 0.5% in 2007. 3The average HIV prevalence among female sex workers in Karnataka was just over 5% in 20074In fact ,as was apparent from the course of this research, HIV infection is not only limited to the sex workers but affects people from all social strata, young married ,Illiterate women included. AIMS AND OBJECTIVES 1) TO STUDY THE CERVICAL CYTOLOGICAL CHANGES IN AFFECTED INDIVIDUALS. 2) TO STUDY THE DIFFERENCES BETWEEN HIV INFECTED AND NON-INFECTED INDIVIDUALS WITH RESPECT TO CERVICAL CHANGES. MATERIAL AND METHODS The study was conducted at BLDUs shri B.M.patil medical college Bijapur.This study was a case-control type of study, conducted with 30 sero-positive cases and the same number of controls. The main objective was to check the incidence of cervical cytologic abnormalities between HIV-positive and HIV-negative patients. Both symptomatic and asymptomatic cases were included in the study conducted for a period of one year (September 2009 - August 2010).The study included pre-menopausal women in the age-group of 20-50 years. OBSERVATIONS AND RESULTS A total of 30 cases were considered. Among them, the highest number of cases belonged to the age-group 35-39, with a total of 9 cases. The CD4 counts ranged from 100-540 in this group; 5 having non-specific inflammatory smear, 2 with normal cervical cytology, 1 with Coccobacillary infection and one with t.vaginalis infection. Next in line were the age-groups 25-29 and 30-34 years with a total of 7 patients in each group. The CD4 counts in the 25-29 group ranged from 54-268.There was one case of LSIL, One case of Inflammatory smear with squamous metaplasia and one with ASC-US. One had normal cervical cytology and the rest were with non specific inflammatory smears. The CD4 counts of patients in the age-group 30-34 years ranged from 70-211. Two among this had inflammatory smears with squmaous metaplasia, 1 had LSIL with HPV infection (CD4 COUNT=87), 1 showed candidiasis, one had normal cervical cytology, 1 had specific coccobacillary infection and the rest were with non-specific inflammatory smears. DISCUSSION In comparison to the cases, the control group had a majority of non-specific inflammatory smears (25 cases), considerably more than that in HIV patients. However cervical cytological abnormalities were found in only 5 of the samples in the control group in comparison to 13 in the HIV positive cervical smears. This is in accordance with the established fact that HIV positive individuals tend to have more opportunistic infections and the incidence of metaplasia and dysplasia is considerably higher in them than in their sero-negative counterparts. “The prevalence of cervical dysplastic lesions present at colposcopic/bioptic examination was 3.2 times greater in HIV+ women than in HIV- women (38% v/s 12%, p<0.001) and that of lesions of a higher degree 7 times greater. Compared to non-HIV+ women, patients who were positive presented more severe dysplastic lesions, a higher frequency of HPV-derived lesions and inflammatory pictures. There was also a correlation between high incidence of dysplastic cervical lesions and advanced stage of immunodepression. The negative predictive value of the Pap test was higher in the seronegatives (95%) than in the seropositives (83%, p<0.01). The overall agreement between cytology and colposcopy/histology was greater in the seronegatives than in the seropositives (87% v/s 74%, p<0.05).�36 Our study showed a correlation between HIV infection and cervical dysplasias as well as opportunistic infections with 16.67% of cases showing opportunistic infections, 16.67% with squamous metaplasia, 6.66% with LISL and 3.33% with ASC-US, both being considerably higher than in the control group of sero-negative cases. Hence our study is in accordance with the established fact that HIV infection predisposes to various cervical cytologic abnormalities. Unlike other studies, our study does not show any case positive for malignancy in the HIV positive group, although there was an HPV infection. This finding can be due to the fact that our study involves both symptomatic and asymptomatic patients and the sample size is limited due to the short duration of study. CONCLUSION The study conducted with the Pap smears of 30 HIV infected cases and 30 controls showed that HIV infection was associated with an increased incidence of opportunistic infections along with dysplasias of the cervix. This is in accordance with various earlier researches which prove the same. This study however could not establish a relationship between cervical carcinoma (malignancy) and HIV infection. Further evaluation in this field is hence needed. Also the cases with Dysplastic changes need to be followed up as there is often rapid progression to malignancy in HIV infected individuals.