LIQUID-BASED CYTOLOGY AND HPV DNA DETECTION IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED WOMEN Quoc-Huy V. NGUYEN1 MD MIAC, Alain P. VERHEST2 MD FIAC, Gilbert QUERTON2 BMA, Patricia BARLOW3 MD, Deborah KONOPNICKI4 MD, Isabelle FAYT5 CT, Jean-Christophe NOEL5 MD MIAC (1) Department of Obstetrics & Gynecology, Hue University Medical School, Hue, Vietnam. (2) Department of Pathology, (3) of Obstetrics & Gynecology, (4) of Infectious Diseases, CHU Saint-Pierre and (5) Department of Pathology, CUB-Erasme, Free University of Brussels, Belgium INTRODUCTION Table 2. Cervical cytology and CD4 cell count Since 1993, invasive cervical cancer had been designated by the Center for Disease Control and Prevention as an AIDS-defining illness. HPV infection plays a crucial role in the development of cervical cancer and its precursors. Liquid-based cytology is a smear preparation method providing better quality of the cells, favoring the detection of abnormal pattern. The correlation between CD4 cell counts and squamous intraepithelial lesions had been established in few studies but still remains equivocal, since this finding has not been reported in all studies. More investigations are needed to clarify the relationship between the immunostatus and HPV infection in HIV-infected women. OBJECTIVE This study aims to evaluate the correlation between the clinical setting of lower genital tract lesions / cytological diagnosis on liquid-based preparation smear/ HPV viral load and HIV status in HIV-infected women. The distribution of LSIL and HSIL differs from group of CD4 cell count <200/mm3 to group of >200/mm3 ( X2 = 6.99, p < 0.01 ). METHODS DISCUSSION Cytological samples of HIV-infected women attending the Outpatient Clinic of the CHU Saint-Pierre during 3 years (1998-2000) were collected for AutoCyte liquid-based preparation method. HPV DNA viral load were assessed with Polymerase Chain Reaction method by using MY09 / MY11 consensus primers. Data concerning cervical, vaginal and vulvar papilloma/condyloma lesions were collected. The CD4 cell count and HIV RNA viral load were assessed at the time of taking cytological sample. Most of patients in our study group were in the reproductive age. Despite the HPV prevalence were very high and 48.39% of patients with benign cytological patterns were HPV DNA positive, the clinical lesions of HPV infection in the lower genital tract are still low, . This discrepancy suggests that all HIV-infected patients should be screened for HPV infection, even without clinical and/or abnormal cytological finfings. With a relative small number of individuals included in the study, all types of squamous cell lesions were founded, with one case of invasive squamous cell carcinoma. Of 58 patients with squamous intraepithelial lesions, HPV DNA could be detected by using Polymerase Chain Reaction in 55 patients (94.83%). The HPV prevalence ranges from 2.8% to 57% in a general non-immunocompromised female population and from 28.9% to 95% in HIV infected women, but it is not possible to compare our findings with those from previous studies because of variation in studies’ population. In our study, the CD4 cell count has not affected the prevalence of HPV DNA viral load and the distribution of cervical lesions ASCUS+. This finding is consistent with those of several previous studies. We observed an increasing percentage of HPV DNA detected in the groups of mild, moderate and high HIV replication, but this difference is not significative. RESULTS 98 patients were included in the study, with the age ranged from 19 to 54, 94.9% (93) aged from 20 to 45. Clinical papilloma /condyloma of the genital tract were found in 19 patients (19.39%). Squamous intraepithelial lesions (LSIL and HSIL) and squamous cell carcinoma incidence was respectively 59.18% and 0.98%; 69.38% of patients have ASCUS+ lesions. CONCLUSION HIV-infected women have a very high incidence of ASCUS+ lesions and HPV prevalence. There was no significant difference in HPV viral load and cervical lesion ASCUS+ in HIV-positive women with CD4 cell count of <200/mm3 and of >200/mm3. REFERENCES 1. Ammatuna P, Giovanelli L, Giambelluca D, Mancuso S, Rubino E, Colletti P, Mazzola G, Belfiore P, Lima R. Presence of humanpapillomavirus and epstein-barr virus in the cervix of women infected with the human immunodeficiency virus. J Med Virol 2000 Dec; 62(4):410-5. 2. Cardillo M, Hagan R, Abadi MA. CD4 T cell count and squamous intraepithelial lesions in human immunodeficiency viruc-infected women. Acta Cytol. 1999;43(5):919. 3. Center for Disease Control and Prevention. 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Morb Mortal Wkly Rep 1992 (RR-17);41:1-19. 4. Ellerbrock TV, Chiasson MA, Bush TJ, Sun XW, Sawo D, Brudney K, Wright TC Jr. Incidence of cervical squamous intraepithelial lesions in HIV-infected women. JAMA. 2000 Feb 23;283(8):1031-7. 5. Jay N, Moscicki AB. Human papillomavirus Infections in women with HIV disease: prevalence, risk and management. The AIDS Reader. 2000;10(11):659-668. 48.39% (15/31) of patients with normal cytological finding and 75% (6/8) with ASCUS were HPV DNA positive. The HPV prevalence in our study was 78.57% (77/98). The incidence of HPV DNA detected in patients with CD4 cell count of <200/mm3 and of >200/mm3 were 86.21% and 75.70% (p>0.05). Table 1. Prevalence of HPV infection compared with HIV viral load Financial disclosure : The authors have no affiliation or financial interest in any companies or products to which this poster may refer. Acknowledgment : This work has been supported by a UICC International Cancer Technology Transfer Fellowship and a Grant from Institut Jules Bordet, Brussels, Belgium