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The Journal of the American Board of Family Practice 17:108-113 (2004)
© 2004 American Board of Family Practice

Genital Dysplasia in Women Infected with Human Immunodeficiency Virus

Gregory Taylor, MD, Tracy Wolff, MD, Niharika Khanna, MD, Priscilla Furth, MD and Patricia Langenberg, PhD*

Department of Family Medicine (GT, TW, NK), University of Maryland, Baltimore
Institute of Human Virology (GT, PF), University of Maryland, Baltimore
Department of Epidemiology (PL), University of Maryland, Baltimore
Greenebaum Cancer Center (GT, NK, PF, PL), University of Maryland, Baltimore

Correspondence: Address correspondence to Gregory Taylor, MD, University of Maryland, 29 S. Greene St., Suite 300, Baltimore, MD 21201

Background: Women infected with human immunodeficiency virus (HIV) are at increased risk for the development of dysplastic genital lesions. Traditionally, markers of immunosuppression were predictive of the development of dysplasia. Recent advances in antiretroviral medications allow restoration of a once-depressed CD4+ cell count and suppression of HIV replication. In this new era, additional predictive markers of genital dysplasia are needed for management of women infected with with HIV.

Objective: To find predictive markers of genital dysplasia in women infected with HIV.

Design: Observational study of a consecutive sample of 200 women infected with HIV from an urban university clinic. Measurements of histopathology, CD4+ count, CD4+ nadir, HIV viral load, human papillomavirus (HPV), and usage of highly active antiretroviral therapy (HAART) were evaluated for an association with genital dysplasia.

Results: There was a trend toward a protective effect against any genital dysplasia when HAART had been prescribed [relative risk = 0.77, 95% confidence interval (CI) 0.56, 1.06] and HAART therapy resulted in an immune response (relative risk, 0.61; 95% CI, 36, 1.02). High-risk HPV DNA was a strong predictor of dysplasia (P = .0003). A lower CD4+ count nadir was strongly associated with genital dysplasia (P = .0003).

Conclusion: A history of greater immunosuppression, as measured by the nadir of a patient’s CD4+ count, is the strongest predictor of genital dysplasia in women infected with HIV.




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[Abstract] [Full Text] [PDF]


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