Dissertação
Comparação entre as colpocitologias oncóticas de mulheres infectadas e não-infectadas pelo vírus da imunodeficiência humana
Fecha
2008-12-12Autor
Homero Caporali de Oliveira
Institución
Resumen
Objectives: The aims of this study were to determine the prevalence of abnormal
cervical smears in women uninfected and infected with the human immunodeficiency
virus (HIV), and to compare the results according to their HIV-status. Method: Two
hundred and thirty two women between the ages of 13 and 60 years were enrolled in
the study: 161 were HIV-infected and 71 uninfected. Those women were excluded
who refused to take part in the research, who had been submitted to histerectomy, or
were pregnant. Data was collected from October 2006 to August 2007 at two different
university health centres. The women were subject to anamnesis and a complete
gynecological examination. The samples were collected using cytobrush and Ayre
spatula. Only conventional Pap smears were performed. Final cytological diagnosis
was performed by the same cytopathologist in all cases. Cervical smears were
reviewed and classified according to the Bethesda System 2001. Those samples
having at least ASCUS were considered abnormal. Cytological, gynecological,
obstetric and socio-demographic variables were considered in the statistical analysis.
Calculations were performed with R Software. Results: The prevalence of abnormal
cytology was 13 (9,3%), ocurring in HIV-infected women only. HIV-infected women
had more ASCUS (p=0,053) and abnormal cytology (p=0,005). Those women with a
lower educational level (<7 years) (OR=2,9;p=0,001), smokers (OR=9,8;p<0,001),
widows (OR=5,5;p=0,001), with higher rates of lifetime sexual partners (p=0,001),
pregnancies (p=0,022) and abortions (p=0,018), as well as those using barrier
contraceptive methods (OR=5,6;p<0,001), with abnormal colposcopy
(OR=33,6;p<0,001), or receiving consultation for reasons of routine control (p<0,001)
were more likely to be HIV-infected. ASCUS, HPV and LSIL (p<0,001) demonstrated
significant differences in the abnormal cervical cytologies, when compared to the
normal ones. In the final multivariable analysis, only abnormal colposcopy
(OR=3,9;p=0,04) and smoking (OR=3,9;p=0,04) showed association with abnormal
cytology. Conclusion: In this study it was not possible to confirm the association
between HIV-infection and abnormal cytology.
KeyWords: HIV-Infection; Vaginal Smears; Cervical Intraepithelial Neoplasia; Human
Papillomavirus; Neoplasms, Squamous Cell.