Cytological Aspects of Cervico-Uterine Smears from HIV/HPV HR Coinfected Women Treated with Antiretrovirals

Abstract

Introduction: Women living with HIV are at high risk of developing persistent HPV-HR infections. This favors the development of precancerous lesions that may progress to cervical cancer. With a view to improving management and taking preventive action against cervical lesions and cervical cancer in women living with HIV, our study aimed to describe cervical abnormalities and establish a relationship between lesion severity and HPV-HR genotypes in HIV/HPV-HR co-infected women. Methodology: This was a descriptive cross-sectional study conducted at the CTAB from March 2021-December 2022. Of 122 women living with HIV screened HPV HR positive 90 presented for FCU. Cervico-uterine smears were read after Papanicolaou staining by two cytopathologists at the anatomy-cytology-pathology laboratory of the university hospital center. Results were rendered according to the 2014 Bethesda system classification, and data processing was performed using SPSS 25 software. Results: 90 patients co-infected with HIV/HPV-HR were included, with a mean age of 44.16±10.08 years, ranging from 20 to 70 years. The women in our study were all on triple therapy, and most had a controlled viral load and CD4 count above 200mm3. Cytological abnormalities accounted for 38.9%, with a predominance of atypical squamous cells of undetermined significance (ASCUS) 51.43%, followed by low-grade squamous intraepithelial lesions (LSIL) 37.14% and 11.43% of atypical squamous cells for which a high-grade lesion could not be excluded (ASC-H). Triple therapy had a protective impact in women against progression to precancerous states, although no statistically significant association was observed between cervical lesions and HR-HPV genotypes (p=0.819). Conclusion: Our study reveals a high proportion of ASCUS lesions in women living with HIV and co-infected with HPV HR. Triple therapy has a protective effect against progression to severe lesions. To this end, screening for precancerous lesions in this population should include diagnosis of the P16 protein by Histoimmuno chemistry. Key words: FCU, HR- HPV, Women, HIV, ARV, Congo.