Prevalence of colpocytological abnormalities in pregnant HIV-positive women and risk factors

BACKGROUND: Coinfection with Human Papillomavirus (HPV) and Human Immunodeficiency Virus (HIV) in pregnant women is a growing problem, posing a high risk of complications and oncologic progression.

PATIENTS AND METHODS: Between January 2010 and December 2016 we enrolled all HIV positive pregnant women referred to our High Risk Pregnancy Center and as controls all HIV negative pregnant women referred to our Colposcopy and Cytology Centre. We performed Pap-test and colposcopy in all patients to evaluate the prevalence of colpocytological abnormalities in each group. One year after delivery, we repeated Pap-tests in all women to assess any evolution of the primary lesions. We also checked for any link between cytological lesions and some features in HIV-positive patients.

RESULTS: In the HIV-positive group the Pap-test was normal in 49 patients (75%), while the colposcopic examination was normal in 42 women (64%). In the control group, the Pap-test was negative in 113 cases (95%), and the colposcopic examination was normal in 112 patients (93%). One year after delivery the Pap-test showed a regression of cytological lesions in both groups, but was statistically significantly higher in HIV-positive women. Finally, HIV-positive women showed a higher prevalence of colpocytological abnormalities, depending on nationality, partner HIV-concordance, CD+ T-cell count and viral load.

CONCLUSION: Our results confirm that HIV-positive pregnant women are an “at risk population” for cervical abnormalities, identifying pregnancy as the best moment to sensitize women about the importance of screening for cervical cancer. Moreover, some features identify subgroups with an increased risk, requiring close follow-up and personalized management.