Cervical neoplastic lesions in relation to CD4 T‐lymphocyte counts and antiretroviral therapy among women with clinical stage 1 HIV in Yunnan, China

Abstract

China lacks data demonstrating associations of cervical neoplastic lesions with CD4 T‐lymphocyte (CD4 cell) counts and antiretroviral therapy (ART) among HIV‐infected women, suggesting relevant investigations are needed. A total of 545 HIV‐infected women were enrolled in Yunnan, China, between 2011 and 2013. CD4 cell counts and ART were measured via medical records and cervical neoplastic lesions were measured by professional pathologists. Multivariable logistic models, which treated cervical intraepithelial neoplasia (CIN) 1+ and CIN2+ as outcomes, calculated adjusted odds ratio (aOR) of CD4 cell counts and ART. Subgroup analysis treating CIN1+ as the outcome was conducted by HIV infection duration (<4 vs ≥4 years), ethnicity (Han vs non‐Han), and study site (Mangshi vs Kunming). The prevalence of CIN1+ and CIN2+ was 17.4% and 7.3%, respectively. Overall, 243 (44.6%) women had CD4 cell counts ≥500 cell/μL, 187 (34.3%) used ART for less than 2 years, and 236 (43.3%) used ART for at least 2 years. We found inverse associations of CIN1+ with CD4 cell counts (≥500 compared to <500 cells/μL: aOR = 0.46, 95% CI = 0.27‐0.79) and ART use (<2 years: aOR = 0.43, 95% CI = 0.21‐0.87; ≥2 years: aOR = 0.54, 95% CI = 0.27‐1.10). Point estimates did not change substantially for CIN2+ but aORs of ART became nonsignificant. No significant interaction was observed for HIV infection duration. We found significant interaction between CD4 cell counts and ethnicity and study site in relation to CIN1+. Our study suggests potential protective effects of high CD4 cell counts against cervical neoplastic lesions among HIV‐infected women, whereas associations of ART are less consistent.

Cytology compared with Hybrid Capture 2 human papilloma virus cervical cancer screening in HIV positive and HIV negative South African women

“…It is possible that early initiation with antiretroviral therapy can lower the incidence and progression of premalignant lesions 27. This study confirmed the findings of other studies that have shown different prevalence distributions in women with different CD4 count categories, despite the small number of patients with CD4 counts of <200 cells/mm 3 in this study 28 29…”

Diagnostic accuracy of cervical cancer screening strategies for high-grade cervical intraepithelial neoplasia (CIN2+/CIN3+) among women living with HIV: A systematic review and meta-analysis

“…Thirteen studies enrolled WLHIV attending cervical cancer screening in outpatient gynaecology clinics, 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 whereas 21 studies recruited WLHIV attending HIV clinics. 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 Two studies recruited WLHIV with a prior positive screen-test (HPV-positive) 58 , 59 and two studies included a combination of women attending primary care and women referred to colposcopy because of positive HPV test and/or abnormal cytology. 60 , 61 The median age of enrolled women within studies ranged from 30 to 50 years (age range: 19 to 68 years).…”

“… 25 , 29 , 30 , 32 , 36 , 37 , 39 , 41 , 42 , 45 , 47 , 48 , 51 , 53 . Twenty-eight studies evaluated any HR-HPV DNA test method for CIN2+ 24 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 45 , 46 , 49 , 50 , 51 , 54 , 55 , 56 , 57 , 60 and 18 for CIN3+; 25 , 28 , 29 , 30 , 33 , 36 , 37 , 39 , 41 , 42 , 45 , 47 , 49 , 50 , 51 , 53 , 60 , 61 these included Hybrid Capture II (HC-II; 16 studies); 27 , 29 , 31 , 34 , 35 , 36 , 37 , 40 ...…”

HIV-Infected Women with Low-Grade Squamous Intraepithelial Lesion on Cervical Cytology Have Higher Risk of Underlying High-Grade Cervical Intraepithelial Neoplasia

“…The study by Zhang et al on the association of cervical neoplastic lesions with CD4 cell counts and the use of ART among HIV-infected women found that the prevalence of cervical neoplasia appeared to be higher in women who had lower CD4 cell counts. The authors concluded that high CD4 cell counts might have protective effects against the development of cervical neoplastic lesions [ 22 ]. Low CD4 cell counts in HIV-infected women indicate the existence of immunosuppression, which can be associated with an increased risk of cervical neoplasia.…”

“…However, such results might be limited by the small number of 20 HIV-positive women in each group. A population-based study among 545 HIV-infected women in China reported no significant interaction between CIN development and duration of HIV infection [ 22 ].…”