Comparative prevalence, incidence and short-term prognosis of cervical squamous intraepithelial lesions amongst HIV-positive and HIV-negative women

Aims and Objectives: The aim of present study is to estimate the frequency of abnormal PAP’s smears and mainly to detect precancerous and cancerous lesions as well as inflammatory lesions in HIV infected women. Methodology: Our study was a retrospective study of total 130 cases and PAP’s smears were examined in cytology section in Department of Pathology, BJ Medical College, Ahmedabad from 1st March 2017 to 31st August 2017. Both HIV positive and HIV negative patients were included in the study. 80 patients were HIV negative and 50 patients were HIV positive. The clinical history and relevant parameters were noted. All the smears were processed by a conventional method using Papanicolaou stain. Results: Out of 130 cases, 118 cases were reported negative for intraepithelial lesions or malignancy (NILM). Five cases were positive for squamous intraepithelial lesions (SIL) out of which four were HIV positive. Seven cases were of atypical squamous cells of undetermined significance (ASCUS) out of which 5 were HIV positive. Three cases were showing bacterial vaginosis. 1 case was showing Trichomonas Vaginalis. 19 cases were showing changes of non-specific inflammation. 6 cases were showing atrophic changes. Conclusion: HIV infected women are at more risk to develop cervical cytological abnormalities. The study revealed a maximum number of non-specific inflammatory smears followed by smears showing atrophic changes. Smears suspicious for malignancy (ASCUS) and smears showing squamous intraepithelial lesions (SIL) were more common in HIV positive patients. Thus regular PAP’s smears screening as recommended by National AIDS Control Organization (NACO) will help in early detection of cervical abnormalities in HIV positive women.

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Relationship between the Cervical Microbiome, HIV Status, and Precancerous Lesions

mBio ◽

10.1128/mbio.02785-18 ◽

2019 ◽

Vol 10 (1) ◽

Cited By ~ 18

Author(s):

Cameron Klein ◽

Daniela Gonzalez ◽

Kandali Samwel ◽

Crispin Kahesa ◽

Julius Mwaiselage ◽

...

Keyword(s):

Hiv Positive ◽

High Grade ◽

Squamous Intraepithelial Lesions ◽

Cervical Lesions ◽

Cervical Cancers ◽

Bacterial Microbiome ◽

Bacterial Richness ◽

Intraepithelial Lesions ◽

Hiv Negative

ABSTRACT Nearly all cervical cancers are causally associated with human papillomavirus (HPV). The burden of HPV-associated dysplasias in sub-Saharan Africa is influenced by HIV. To investigate the role of the bacterial microbiome in cervical dysplasia, cytobrush samples were collected directly from cervical lesions of 144 Tanzanian women. The V4 hypervariable region of the 16S rRNA gene was amplified and deep sequenced. Alpha diversity metrics (Chao1, PD whole tree, and operational taxonomic unit [OTU] estimates) displayed significantly higher bacterial richness in HIV-positive patients (P = 0.01) than in HIV-negative patients. In HIV-positive patients, there was higher bacterial richness in patients with high-grade squamous intraepithelial lesions (HSIL) (P = 0.13) than those without lesions. The most abundant OTUs associated with high-grade squamous intraepithelial lesions were Mycoplasmatales, Pseudomonadales, and Staphylococcus. We suggest that a chronic mycoplasma infection of the cervix may contribute to HPV-dependent dysplasia by sustained inflammatory signals. IMPORTANCE HPV is known to be the causal agent in the majority of cervical cancers. However, the role of the cervical bacterial microbiome in cervical cancer is not clear. To investigate that possibility, we collected cervical cytobrush samples from 144 Tanzanian women and performed deep sequencing of bacterial 16S rRNA genes. We found that HIV-positive patients had greater bacterial richness (P = 0.01) than HIV-negative patients. We also observed that women with high-grade squamous intraepithelial lesions (HSIL) had greater cervical bacterial diversity than women with cytologically normal cervices. Data from our precise sampling of cervical lesions leads us to propose that Mycoplasma contributes to a cervical microbiome status that promotes HPV-related cervical lesions. These results suggest a greater influence of the bacterial microbiota on the outcome of HPV infection than previously thought.

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