Human papillomavirus (HPV) infection and abnormal cervical cytopathology among human immuno- deficiency virus (HIV) positive women in Northern India

Human immune deficiency virus (HIV) infection is associated with a higher risk of human papillomavirus (HPV) positivity and cervical intraepithelial neoplasia (CIN) which may progress to cancer. Hence, it is important to screen all HIV positive women for this cancer which is amenable to cure in early stages. A cross sectional case-control study was conducted on 100 HIV seropositive women and matched seronegative controls attending Lok Nayak Hospital, New Delhi to study the prevalence of HPV infection and abnormal cervical cytopathology. A detailed cervical evaluation including a per-speculum examination, pap smear, cervical scrape for HPV DNA polymerase chain reaction (PCR), visual inspection of cervix with acetic acid, colposcopy and guided biopsy were done. Abnormal pap smears were found in 63% women of which 10% were squamous intraepithelial lesions. Biopsy revealed cervical intraepithelial neoplasia in 2% of all cases (5.6% of all patients biopsied). Prevalence of HPV in HIV positives was 24% compared to 4% in controls (p value 0.001), also bearing a significant correlation with CIN, thus placing HIV positives at a higher risk for cervical dysplasias and cancer. The sensitivity of HPV DNA test for detection of cervical dysplasias was 86.3% and specificity 64.2%. HIV positivity predisposes to invasive cervical cancer on account of immunosuppression and co-existing HPV infection, thereby the need for aggressive screening for cervical intraepithelial lesions. Both HPV DNA PCR and pap smear are optimal screening tools in these women.