We assessed the association between different HPV genotypes, HIV infection, and cervical squamous intra‐epithelial lesions (SIL) in 236 women with known HIV serostatus enrolled in a longitudinal multicentric study in Italy. Of these women, 135 were HIV‐infected, and were not markedly different from HIV‐negative women with regard to demographic characteristics, sexual practices, smoking, or intravenous drug use. We obtained 232 cervical smears suitable for cytological examination and HPV‐genotype analysis (134 from HIV‐positive women and 98 from HIV‐negative women). For 86 HIV‐positive and 89 HIV‐negative women, the smears appeared normal at cytomorphological analysis. Cytological dysplasia of varying degrees was detected in 48 smears from HIV‐positive women and in 9 from HIV‐negative women. HPV prevalence, assessed using polymerase‐chain‐reaction analysis, did not significantly differ between HIV‐positive and HIV‐negative women. The prevalence of HPV‐associated SIL was much greater among HIV‐infected women. The most frequently detected genotypes in both groups were HPV 16 and HPV 18. The prevalence of HPV 16 among HIV‐positive women was similar to that for HIV‐negative women; this was also true for HPV 18. However, in the HIV‐positive group, most of these genotypes were associated with SIL. HIV‐positive women showed a wider spectrum of genotypes, including non‐oncogenic and rare types. An association between SIL and HIV infection was confirmed for all HPV genotype classes. Int. J. Cancer 72:982–986, 1997. © 1997 Wiley‐Liss, Inc.

Our findings support the validity of the vaginal Pap smear in diagnosing BV and suggest the screening of such a disease.

We assessed the association between different HPV genotypes, HIV infection, and cervical squamous intra‐epithelial lesions (SIL) in 236 women with known HIV serostatus enrolled in a longitudinal multicentric study in Italy. Of these women, 135 were HIV‐infected, and were not markedly different from HIV‐negative women with regard to demographic characteristics, sexual practices, smoking, or intravenous drug use. We obtained 232 cervical smears suitable for cytological examination and HPV‐genotype analysis (134 from HIV‐positive women and 98 from HIV‐negative women). For 86 HIV‐positive and 89 HIV‐negative women, the smears appeared normal at cytomorphological analysis. Cytological dysplasia of varying degrees was detected in 48 smears from HIV‐positive women and in 9 from HIV‐negative women. HPV prevalence, assessed using polymerase‐chain‐reaction analysis, did not significantly differ between HIV‐positive and HIV‐negative women. The prevalence of HPV‐associated SIL was much greater among HIV‐infected women. The most frequently detected genotypes in both groups were HPV 16 and HPV 18. The prevalence of HPV 16 among HIV‐positive women was similar to that for HIV‐negative women; this was also true for HPV 18. However, in the HIV‐positive group, most of these genotypes were associated with SIL. HIV‐positive women showed a wider spectrum of genotypes, including non‐oncogenic and rare types. An association between SIL and HIV infection was confirmed for all HPV genotype classes. Int. J. Cancer 72:982–986, 1997. © 1997 Wiley‐Liss, Inc.

This study aimed to identify risk factors for squamous intraepithelial lesions (SIL) in women with known HIV status and to explore the association between SIL, HPV subtype, and HIV-induced immunosuppression. The study population consisted of women with known HIV serological status who were attending a network of 16 clinical centres in Italy. Detailed behavioural data, clinical and laboratory parameters, and samples for diagnosis of SIL by Papanicolau smear and HPV infection using a polymerase chain reaction (PCR) were obtained from each study participant. The strength of the association between SIL and possible risk factors was assessed calculating crude and adjusted odds ratios derived from univariate analysis and multivariate models. We enrolled 236 women, of whom 135 (57.2%) were HIV-infected. SIL was diagnosed in 57 women (24.1%); of these, 48 (35.6%) were HIV-infected and 9 (8.9%) were HIV-negative. HPV-DNA was detected in 41 (72%) women with SIL and in 45 (25%) women without SIL. HPV-DNA was more often detected among HIV-infected women than among HIV-negative women (40% vs. 32%), but the difference was not statistically significant. Women infected with high-risk types or with low-risk-uncharacterised types of HPV both had a higher risk of SIL compared with HPV-negative women (respectively, AOR: 17.53 and AOR: 2.89). HIV-infected women with severe or moderate immunosuppression were more likely to have SIL than HIV-negative women (respectively, AOR: 7.29 and AOR: 3.09) also independently from HPV infection. Women reporting use of a contraceptive pill had a 2.5 times higher risk of SIL compared with those who never used hormonal contraceptives. The results confirm that high-risk HPV types are strongly associated with SIL, and that HIV infection may strengthen the effect of HPV at cervical level. The use of oral contraceptives may slightly increase the risk of SIL in women with at-risk behaviour for HIV infection.

Diagnostic cytology has not kept pace with the general growing interest in nonspecific vaginitis (NSV). This study on 114 patients compares Papanicolaou vaginal smears with bacteriologic cultures, whiff test, gram-stained vaginal smears, and vaginal pH in the evaluation of nonspecific vaginitis. Cytology is a valid practical test for diagnosis for nonspecific vaginitis; however, it must be emphasized that the coccoid morphotype is the same as the Gardnerella morphotype. Perhaps the Gardnerella morphotype is the most typical of all the inflammatory typologies found in vaginal smears, and it was indeed one of the first to be described in the history of diagnostic cytology--albeit with a slight misnomer. The question is of considerable importance since NSV is the most frequent and persistent of all collapses of the vaginal ecosystem. Cases of NSV must be screened to prevent more serious diseases of the female genital tract.