Prevalence of HPV infection and cervical intraepithelial lesions in HIV positive and negative women in the city of Florianopolis / Prevalência da infecção pelo HPV e lesões intraepiteliais cervicais em mulheres HIV positivas e negativas na cidade de Florianópolis

Introduction: HPV infection is the most frequent sexually transmitted infection in women. The high oncogenic risk HPV, associated with others factors, there are a risk of progressing to a precancerous lesion of the cervix and even cancer. This evolution is related to the persistence of the infection and other factors, mainly those that interfere with the woman's immunity. The immunosuppression caused by HIV infection is an important factor for viral persistence and the appearance of these lesions. Objectives: To compare the prevalence of HPV infection and cervical intraepithelial lesions in HIV-positive and negative women and describe the possible associated risk factors. Methods: The sample consisted of 50 HIV positive women (study group) and 50 HIV negative women (control group) recruited from the public health system of Florianópolis during the months of January to April 2022. Cervical samples were collected for cytological analysis and for detection of high-risk oncogenic HPV DNA by polymerase chain reaction (PCR). Categorical variables were compared using the chi-square test, with a significance level set at 5% Results: HPV infection was more prevalent in the control group, however, HIV positive women had a higher frequency of intraepithelial lesions diagnosed on cytology. Factors such as greater number of sexual partners, depression and smoking were more frequent in the group of HIV positive women. The number of CD4 T cells less than 200 cels/mm3 was associated with a higher number of altered Pap smears and a positive HPV DNA test. The use of combination antiretroviral therapy and undetectable viral load were associated with a greater number of normal cytology and undetected HPV DNA. Conclusion: The prevalence of cervical intraepithelial lesions in HIV-infected women is higher than in women without infection. The presence of HIV infection was the most important risk factor associated with the development of cervical lesions. (AU)

Introdução: O Papilomavírus Humano (HPV) é a infecção de transmissão sexual mais frequente na mulher. O HPV de alto risco oncogênico, associado a outros fatores, apresenta risco de evoluir para uma lesão pré-cancerosa do colo de útero e até mesmo para o câncer. Essa evolução está relacionada à persistência da infecção e outros fatores, principalmente os que interferem na imunidade da mulher. A imunossupressão causada pela infecção HIV é um fator importante para a persistência viral e o aparecimento destas lesões. Objetivos: Comparar a prevalência da infecção pelo HPV e das lesões intraepiteliais do colo de útero em mulheres HIV positivas e negativas, e descrever os possíveis fatores de risco associados. Métodos: A amostra foi composta por 50 mulheres HIV positivas (grupo de estudo) e 50 mulheres HIV negativas (grupo controle) recrutadas no sistema público de saúde de Florianópolis durante os meses de janeiro a abril de 2022. Foram coletadas amostras cervicais para análise citológica e para detecção do DNA HPV de alto risco oncogênico por reação em cadeia da polimerase (PCR). As variáveis categóricas foram comparadas pelo teste qui-quadrado, com nível de significância estabelecido em 5%. Resultados: A infecção pelo HPV foi mais prevalente no grupo controle, entretanto, as mulheres HIV positivas tiveram uma maior frequência de lesões intraepiteliais diagnosticadas na citologia. Os fatores como maior número de parceiros sexuais, depressão e tabagismo foram mais frequentes no grupo de mulheres HIV positivas. O número de células TCD4 inferior a 200 células/mm3 esteve associado a maior número de colpocitologias alteradas e teste DNA HPV positivo. O uso da terapia antirretroviral combinada e a carga viral indetectável estiveram associadas a um número elevado de citologias normais e DNA HPV não detectado. Conclusão: A prevalência de lesões intraepiteliais do colo do útero em mulheres infectadas pelo HIV foi maior que em mulheres soronegativas. A presença de infecção pelo HIV foi o fator de risco mais importante associado ao desenvolvimento de lesões cervicais.Palavras-chave: HPV. HIV. coinfecção. lesões intraepiteliais escamosas cervicais. prevalência.. (AU)

Análise dos coeficientes de exames citopatológicos realizados e alterados no Paraná / Analysis of the coefficients of cytological examination performed and altered in Paraná / Análisis de los coeficientes de examenes citopatológicos realizados y cambios en Paraná

Objetivo: Analisar o comportamento dos coeficientes de exames citopatológicos realizados e alterados em mulheres Paranaenses no período de 2006 a 2014. Método: Estudo transversal do tipo ecológico, utilizou dados do Sistema de Informação do Câncer do Colo do Útero, segundo faixa etária de 15 a 59 anos. Foi calculada a razão entre o número de casos de câncer de colo uterino, segundo a faixa etária, e mulheres paranaenses da mesma faixa etária, divididos por 100.000. Resultados: Apresentaram-se segundo estatística descritiva, utilizando gráficos e tabelas. Mostraram um aumento de exames realizados nas faixas etárias 15-19 e 50-59 anos, e quedas nas centrais, 20-49 anos. Os exames alterados aumentaram no período estudado nas faixas de 15-19 e 30-49 anos, e caíram nas demais. Conclusão: O estudo evidencia uma mudança no perfil daquelas que procuram o exame citopatológico, com aumento da busca pelas jovens, assim como de exames alterados nas mesmas

Objective: Analyze the behavior of the coefficients of cytological examination performed and altered in women from Paraná between 2006 and 2014. Methods: Cross-sectional study of the ecological type used data from the Cervical Cancer Information System, according to the age range of 15 to 59 years old. The ratio between the number of cervical cancer cases according to age group and women of the same age group, divided by 100,000, was calculated. Results: Were presented according to descriptive statistics, using graphs and tables. Conclusion: There was an increase in the number of examples performed in the 15-19 and 50-59 age groups, and in the age group 20-49. The altered exams increased in the studied period in the groups 15-19 and 30-49 and fell in the others. The study evidences a change in the profile of those who seek the cytological examination, with an increase in the demand by the younger, as well as altered exams in the same ones

Objetivo: Analizar el comportamiento de los coeficientes del examen citológico realizado y alterado en mujeres de Paraná entre 2006 y 2014. Método: Estudio transversal del tipo ecológico utilizó datos del Sistema de Información del Cáncer Cervical, de acuerdo con el rango de edad de 15 a 59 años de edad. Se calculó la relación entre el número de casos de cáncer cervical según el grupo de edad y las mujeres del mismo grupo de edad, dividido por 100.000. Resultados: Se presentaron de acuerdo con estadísticas descriptivas, usando gráficos y tablas. Hubo un aumento en el número de exámenes realizados en los grupos de 15-19 y 50-59 años, y en los grupos de edad de 20-49. Los exámenes alterados aumentaron en el período estudiado en los grupos 15-19 y 30-49 años y disminuyeron en los otros. Conclusión: El estudio evidencia un cambio en el perfil de quienes buscan el examen citológico, con un aumento en la demanda por parte de los más jóvenes, así como también exámenes alterados en los mismos

Cumplimiento del flujo de decisiones clínicas de los algoritmos de derivación y confirmación diagnóstica del primer PAP atípico H1- Santiago Sur / Compliance with the flow of clinical decisions of the algorithms for referral and diagnostic confirmation of the first atypical PAP H1- Santiago Sur

RESUMEN Antecedentes: Un algoritmo puede definirse como un conjunto de operaciones y procedimientos que se deben seguir con el fin de resolver un problema. Objetivo: Conocer el cumplimiento del flujo de decisiones clínicas del protocolo preconizado en los algoritmos de derivación y de confirmación diagnóstica para la citología cervical atípica de significado indeterminado - H1, estipulados en el Programa Nacional de Búsqueda y Control del Cáncer Cervical de Chile. Métodos: Estudio epidemiológico de tipo descriptivo, observacional, cuantitativo y de seguimiento de una cohorte de mujeres portadoras de un primer informe de citología cervical atípica de significado indeterminado - H1, pertenecientes a los consultorios de Atención Primaria de Salud del área Metropolitana Sur de Santiago, Chile. El seguimiento fue a través de la aplicación de los "Algoritmo de derivación a especialista o U.P.C. del primer PAP atípico según la clasificación Bethesda 2001" y "Algoritmos para confirmación diagnóstica". Resultados: Se seleccionaron 446 mujeres con un primer informe H1. El cumplimiento de conductas de acuerdo al algoritmo de derivación fue de 42.4% y las conductas alternativas fue de 5.8%. La adherencia de conducta en los algoritmos para confirmación diagnóstica fue cumplida en un 89.6%. Conclusiones: El cumplimiento de las conductas ajustadas a algoritmo de derivación del primer Pap atípico fue realizado por la mitad de las mujeres y el cumplimiento del algoritmo de confirmación diagnóstica fue realizado por la gran mayoría.

SUMMARY Background: An algorithm can be defined as a set of operations and procedures that must be followed in order to solve a problem. Objective: Determine the compliance of the clinical decisions flow and procedures recommended by the ASCUS results derivation and diagnostic confirmation algorithms established in the National Program of Search and Control of Cervical Cancer of Chile. Methods: An epidemiological, descriptive, observational and quantitative study of a follow up investigation of a cohort of women with ASCUS cytological reports. These women belonging in the health care centers in the South Metropolitan area of Santiago de Chile. The algorithms "The Specialist Derivation Algorithm or UPC for the first atypical Pap according to the Bethesda 2001 classification" and "Diagnosis Confirmation Algorithm" were used for the follow-up process of these patients. Results: Women with a first ASCUS report were selected (n = 446). The compliance of the clinical decisions flow to derivation algorithm was 42.4% and alternative behaviors were 5.8%. In the diagnosis confirmation algorithm was 89.6% the compliance the recommended procedures. Conclusion: Half ASCUS carrier women followed the procedures recommended by the derivation algorithm. In the algorithms of diagnostic confirmation it is met mostly.

Incidence of Cervical Human Papillomavirus and Cervical Intraepithelial Neoplasia in Women with Positive and Negative HIV Status / Incidência de infecção cervical pelo vírus papiloma humano e neoplasia intraepitelial cervical em mulheres com sorologia positiva e negativa para o HIV

Abstract Objectives To evaluate the incidence and factors associated with cervical intraepithelial neoplasia (CIN) and cervical infection by human papillomavirus (HPV) among HIV-positive and HIV-negative women. Methods A cohort of 103 HIV positive and 113 HIV negative women were monitored between October 2008 and February 2012, for at least one year. Procedures included cervical cytology, DNA/HPV detection by polymerase chain reaction, colposcopy with biopsy if necessary, followed by an interview for exposure characteristics data. CIN was based on the histopathological results. Results The incidence of CIN was of 8.8 and 4.6 cases/100 women-years in HIVpositive and HIV-negative women, respectively. HIV-positive women presented a hazard ratio (HR) of 2.8 for CIN and developed lesions earlier (0.86 year) than HIVnegative women (2 years) (p = 0.01). The risk of developing CIN decreased with age (HR = 0.9) and marital status (HR = 0.4). HPV patients presented a higher incidence of CIN when compared HIV-positive and HIV-negative women (p = 0.01). The incidence of HPV cervical infection was 18.1 and 11.4 cases/100 women-years in HIV-positive and HIV-negative women, respectively. Those HIV-positive presented earlier HPV infection (p = 0.002). The risk of developing HPV infection decreased with age and was higher among HIV-positive women. HPV 16 was the most common type in HIV-positive women, and also the type most closely associated with CIN in HIV-negative women. Conclusions HIV-positive women had a greater incidence of HPV and CIN, and in a shorter time interval. More rigorous and timely clinical control is required for this group.

Resumo Objetivos Avaliar a incidência e fatores associados com neoplasia intraepitelial cervical (NIC) e infecção cervical pelo Papiloma Vírus Humano (HPV) entre mulheres HIV positivas e negativas. Métodos Coorte de 103 mulheres positivas para o HIV e 113 negativas, que foram acompanhadas entre outubro de 2008 a fevereiro de 2012, com seguimento mínimo de um ano. Os procedimentos realizados foram coleta de material cervical para citologia oncótica e detecção do DNA/HPV pela reação em cadeia da polimerase, colposcopia seguida de biópsia, se necessário, e entrevista para obter dados e características de exposição. O diagnóstico de NIC foi baseado no resultado histopatológico das biópsias. Resultados A incidência pessoas-tempo de NIC foi de 8,8 e 4,6 casos/100 mulheresano para as mulheres HIV-positivas e HIV-negativas, respectivamente. As HIV-positivas apresentaram uma razão de risco (HR) de 2,8 para NIC e desenvolveram lesões mais precocemente (0,86 ano) do que as negativas (2 anos) (p = 0,01). O risco de desenvolver NIC diminuiu com a idade (HR = 0,9) e o estado civil (HR = 0,4). Pacientes com HPV apresentaram maior incidência de NIC, quando comparadas as mulheres HIVpositivas e as negativas (47,6 10,5%) (p = 0,01). A incidência de infecção cervical pelo HPV, por pessoa/tempo, foi de 18,1 e 11,4 casos/100 mulheres-ano, respectivamente para mulheres HIV-positivas e negativas. As HIV-positivas apresentaram HPV mais precocemente (p = 0,002). O risco de apresentar HPV diminuiu com a idade e foi maior entre as HIV-positivas. O HPV 16 foi o tipo mais comum entre as mulheres HIVpositivas. Conclusões As mulheres HIV-positivas tiveram maior incidência de HPV e NIC, e um menor intervalo de tempo. Controle clínico mais rigoroso e oportuno é requerido para este grupo.

Prevalência de infecção cervical por papilomavírus humano e neoplasia intraepitelial cervical em mulheres HIV-positivas e negativas / Prevalence of cervical infection by human papillomavirus and cervical intraepithelial neoplasia in HIV-positive and negative women

OBJETIVO: Realizar estudo comparativo entre mulheres positivas e negativas para o vírus da imunodeficiência humana (HIV), analisando: prevalência de neoplasia intraepitelial cervical (NIC) e infecção cervical pelo papilomavírus humano (HPV); risco viral e relação com desenvolvimento de NIC; parâmetros sociodemográficos e de comportamento que influenciaram na presença de infecção cervical por HPV e NIC. MÉTODOS: Estudo comparativo entre mulheres positivas e negativas para o HIV, sendo analisadas, respectivamente, 202 e 171 mulheres para avaliar a prevalência de NIC e 164 e 100 mulheres para avaliar a prevalência de infecção cervical pelo HPV. Em todas as consultas foram realizados: coleta de amostras cervicais para realização de citologia oncótica e reação em cadeia da polimerase (PCR) para detecção do DNA-HPV; colposcopia; questionário padronizado para coleta de dados demográficos/comportamentais; biópsia de todas as alterações colposcópicas. O exame histopatológico foi o padrão-ouro para o diagnóstico de NIC. RESULTADOS: A prevalência de NIC foi de 2,4 e 15,3% (p<0,001) e de infecção cervical pelo HPV foi de 37,1 e 55,5% (p=0,002), respectivamente, nas negativas e positivas para o HIV. As soropositivas tiveram mais infecção por HPV de alto risco (35,7 e 23,6%; p=0,02) e por múltiplos tipos (6,2 e 0%). O HPV 16 foi o tipo prevalente, ocorrendo em 11,3 e 10,2% das positivas e negativas para o HIV e também nas mulheres que tiveram NIC nos dois grupos. Os fatores associados ao desenvolvimento de NIC foram: infecção pelo HIV (HT=4,64; IC95% 2,23-9,65), idade (HT=0,95; IC95% 0,93-0,98 para cada ano de vida) e estado civil (HT=0,49; IC95% 0,30-0,80). Os fatores associados à infecção pelo HPV foram: presença do HIV (HT=2,72; IC95% 1,77-4,17), maior número de parceiros sexuais (HT=1,87; IC95% 1,23-2,84), idade (HT=0,97; IC95% 0,95-0,99 para cada ano de vida) e estado civil (HT=0,65: IC95% 0,42-1,0 para união estável/viúvas). CONCLUSÃO: A ...

PURPOSE: To conduct a comparative study between two groups of women (HIV positive and negative) analyzing: the prevalence of cervical intraepithelial neoplasia (CIN) and cervical HPV infection; viral risk and relationship with development of CIN; and sociodemographic and behavioral parameters that influence cervical HPV infection and the development of CIN. METHODS: A cross-sectional study in which 202 HIV-positive women and 164 HIV-negative women were analyzed to assess the prevalence of CIN and 171 HIV-positive women and 160 HIV-negative women were analyzed to assess the prevalence of cervical HPV infection. The following procedures were performed on the occasion of each medical visit: collection of cervical samples for cytology and polymerase chain reaction (PCR) to detect HPV DNA; colposcopy; standardized questionnaire to collect demographic and behavioral data; and biopsy of all colposcopic changes. Histopathology was the gold standard for the diagnosis of CIN. RESULTS: The prevalence of CIN was 2.4 and 15.3% (p<0.001) and the prevalence of cervical HPV infection was 37.1 and 55.5% (p=0.002), respectively, among HIV-negative and -positive women. HIV-positive women had a higher risk of HPV infection (35.7 and 23.6%) (p=0.02). HPV 16 was the most prevalent virus type, occurring in 11.3 and 10.2% of HIV-positive and negative women and was also more prevalent among women presenting CIN in both groups. Factors associated fwith the development of CIN were: HIV infection (HT=4.64; 95%CI 2.23-9.65), age (HT=0.95; 95%CI 0.93-0.98 for each year of life) and marital status (HT=0.49; 95%CI 0.30-0.80). Associated factors for HPV infection were: HIV presence (HT=2.72; 95%CI 1.77-4.17), greater number of sexual partners (HT=1.87; 95%CI 1.23-2.84), age (HT=0.97; 95%CI 0.95-0.99 for each year of life) and marital status (HT=0.65; 95%CI 0.42-1.0 for stable union/widows). CONCLUSION: The prevalence of CIN and cervical HPV infection was higher in ...

Prevalência de lesões precursoras para o câncer de colo do útero nas regiões do Brasil e sua relação com a cobertura do programa de rastreamento / The prevalence of Precursor lesions for cervical cancer in regions of Brazil it?s relations hip with the screening program

O objetivo deste estudo foi realizar um levantamento de publicações existentes em periódicos que avaliam lesões precursoras do câncer de colo do útero e sua taxa de cobertura nas regiões brasileiras. Os resultados do levantamento de publicações já existentes apontam que os dados das lesões precursoras e o câncer de colo do útero são desencontrados em todas as regiões, este fato nos atentou para a realização do cálculo da cobertura aproximada. Baseado nos registros publicados pelo DATASUS, a cobertura por região foi de aproximadamente 8,5% no Sudeste (sendo a melhor cobertura entre as regiões do Brasil); Nordeste, 7,5%; Sul, 6,8%; Centro-Oeste, 6,4%; e Norte, 5,9%, sendo essa a pior cobertura entre as regiões brasileiras. Concluímos que a deficiência no sistema de rastreamento do câncer do colo do útero é um problema que atinge todas as regiões; logo, faz-se necessário a intensificação do programa de rastreamento para atingir o maior contingente de mulheres.(AU)

The objective of this study was to search of any existing publication in the literature that evaluates precursor lesions of cervical cancer and its rate in the Brazilian regions. The results of the researched publications already existing pointed to the data of precursor lesions of cervical cancer to be inexistent on all the regions, this fact brought up the attention to calculate the approximate coverage. Based in records published by DATASUS, the coverage by region was approximately 8.5% in the Southeast (being the best coverage of Brazil), Northeast, 7.5%; South, 6.8%; Central-West, 6.4% and 5.9% in the North, which was the worst of all the Brazilian areas. We conclude that a deficiency during the tracking research of the cervical cancer is a problem that affects all regions, so naturally it is necessary to intensify a tracking program to achieve and reach a larger number of women.(AU)

Historia natural de la infección por el virus del papiloma humano: una actualización / Natural history of the infection for human papillomavirus: an actualization

Durante los últimos años, se han sucedido grandes avances en nuestro entendimiento acerca de la biología e historia natural del Virus del Papiloma Humano (VPH). La mayoría de las infecciones por papiloma virus son transmitidas por un contacto cercano bien sea de piel a piel o mucosa a mucosa. La relación sexual con penetración no es un requerimiento para la transmisión del VPH. Las infecciones orales y digitales por VPH ocurren, y existe evidencia de que el contacto digital-genital y genital-oral puede resultar en la transmisión del VPH, aunque en un porcentaje relativamente bajo. La transmisión vertical de la madre al feto es una vía frecuente de infección, de hecho, se reconoce que más del 80% de los neonatos nacido de madres infectadas con VPH genital serán positivos a la determinación del ADN del VPH en la región naso-faríngea y mucosa oral. Mujeres con infecciones transitorias frecuentemente desarrollan anormalidades citológicas mientras ocurra una replicación activa del VPH. Esto ocurre debido a que las infecciones productivas de VPH resultan en anormalidades citológicas en las células epiteliales infectadas. La fuerte asociación entre el riesgo de infección por VPH y el incremento en la supresión inmune apoya un efecto biológico directo de la infección por VIH en la historia natural del VPH.

In recent years, there have been major advances in our understanding of the biology and natural history of Human Papilloma Virus (HPV). Most papillomavirus infections are transmitted by close contact of either skin to skin or mucosa to mucosa. Sexual intercourse is not a requirement for genital HPV infection. Digital-oral infections occur and there is evidence that digital-genital and oral-genital contacts can result in the transmission of HPV, although in a relatively low percentage. Vertical transmission from mother to fetus is a common route of infection; in fact, it is recognized that more than 80% of infants born from mothers infected with genital HPV will be positive for HPV DNA determination in the nasal-pharyngeal region and oral mucosa. Women with transient infections often develop cytological abnormalities that take place while there is active HPV replication. This occurs because productive HPV infections result in cytological abnormalities in infected epithelial cells. The strong association between the risk of HPV infection and increased immune suppression, supports a direct biological effect of Human Immunodeficiency Virus (HIV) infection on the natural history of HPV.

Condom and oral contraceptive use and risk of cervical intraepithelial neoplasia in Australian women / 부인종양

OBJECTIVE: To assess the association between condom use and oral contraceptive consumption and the risk of cervical intraepithelial neoplasia (CIN). METHODS: A cross-sectional study was conducted in Perth clinics. A total of 348 women responded to the structured questionnaire. Information sought included demographic and lifestyle characteristics such as the use of condom for contraception, consumption of oral contraceptive, and duration of oral contraceptive usage. Crude and adjusted odds ratio (OR) and associated 95% confidence interval (CI) were calculated using unconditional logistic regression models and reported as estimates of the relative risk. RESULTS: The prevalence of CIN was found to be 15.8%. The duration of oral contraceptive consumption among women with abnormal Papanicolaou (Pap) smear result indicating CIN was significantly shorter than those without abnormal Pap smear result (mean+/-SD, 5.6+/-5.2 years vs. 8.2+/-7.6 years; p=0.002). Comparing to or =10 years reduced the risk of CIN (p=0.012). However, use of condom for contraception might not be associated with a reduced risk of CIN after accounting for the effects of confounding factors (adjusted OR, 0.52; 95% CI, 0.05 to 5.11; p=0.577). CONCLUSION: Use of oral contraceptives, but not condoms, for contraception appeared to be inversely associated with CIN. Prolonged use of oral contraceptive demonstrated its benefits of reducing the risk of CIN.

¿Cómo afecta el tipo de seguro de salud a la realización del Papanicolaou en Perú? / How does type of health insurance affect receipt of Pap testing in Peru?

OBJETIVO: Describir la asociación entre la realización de la citología del cuello uterino y el tipo de seguro de salud en las mujeres peruanas, y determinar el papel de las variables sociodemográficas y de salud sexual en esta relación. MÉTODOS: Se realizó un estudio transversal que utiliza la información de la Encuesta Demográfica y de Salud Familiar (ENDES), Perú, 2005-2008, correspondiente a una selección de 12 272 mujeres de 30 a 49 años de edad. La variable dependiente fue la realización de alguna prueba de Papanicolaou (PAP) en los últimos 5 años. Las variables independientes principales fueron el tipo de seguro de salud, el nivel educativo, el nivel socioeconómico del hogar, la etnia y el área de residencia. La asociación multivariada fue estimada a través de la razón de prevalencias, utilizando la regresión Poisson con varianza robusta. RESULTADOS: Se encontró que 62,7% de las mujeres sexualmente activas se habían realizado algún PAP en los últimos 5 años. Este porcentaje de participación variaba según el tipo de seguro de salud, donde las mujeres con seguro público tenían 1,27 (intervalo de confianza de 95% [IC95%]: 1,24-1,31) y las que tenían seguro privado 1,52 (IC95%:1,46-1,58) veces mayor probabilidad de haberse realizado un PAP que aquellas sin seguro. Esta asociación era explicada predominantemente por las variables de posición socioeconómica. Asimismo las mujeres que tenían la participación más baja eran las analfabetas o con educación primaria, de nivel socioeconómico bajo, con antecedente de lengua indígena y que vivían en la zonas rurales-siendo esta brecha aún mayor cuando además carecían de seguro de salud, llegando a ser hasta la tercera parte en relación con los grupos sociales más favorecidos. CONCLUSIONES: Se hallaron desigualdades según el tipo de seguro de salud en la realización del PAP, siendo las mujeres sin seguro las que menos lo utilizaron, lo cual supone una barrera para el acceso al cribado de cáncer de cérvix en Perú.

OBJECTIVE: Describe the association between receipt of cervical cytology and type of health insurance in Peruvian women, and determine the role of sociodemographic and sexual health variables in this relationship. METHODS: A cross-sectional study using information on a sample of 12 272 women aged 30 to 49 years from the Demographic and Family Health Survey (ENDES), Peru, 2005-2008. The dependent variable was receipt of at least one Pap smear in the last five years. The primary independent variables were type of health insurance, educational level, household socioeconomic level, ethnicity, and place of residence. Prevalence ratio, obtained from Poisson regression with robust variance, was used to measure multivariate association. RESULTS: Among sexually active women, 62.7% had received at least one Pap test in the last five years. Percentage of women tested varied by type of health insurance. Women with public or private insurance had a greater probability of having received a Pap smear-1.27 (95% CI, 1.24-1.31) and 1.52 (95% CI, 1.46-1.58) times greater, respectively-than uninsured women. This association was primarily explained by socioeconomic status variables. In addition, women who participated the least in screening were characterized by illiteracy or only a primary education, low socioeconomic level, speaking an indigenous language, and living in a rural area. When they also lacked health insurance, the gap widened, rising to as much as one third compared to more advantaged social groups. CONCLUSIONS: Inequalities were found in receipt of Pap testing according to type of health insurance; women without insurance were least likely to be screened, implying existence of a barrier to cervical cancer screening in Peru.

Determinantes da detecção de atipias celulares no programa de rastreamento do câncer do colo do útero no Rio de Janeiro, Brasil / Determinants of cellular atypia detection in the cervical screening program in Rio de Janeiro, Brazil

OBJETIVO: Identificar os principais determinantes da detecção de atipias celulares no programa de rastreamento do câncer do colo do útero no Estado do Rio de Janeiro, utilizando os dados do Sistema de Informação do Câncer do Colo do Útero (SISCOLO). MÉTODOS: Uma amostra aleatória de 65 535 exames citopatológicos realizados em 2007 foi obtida do SISCOLO. Essa amostra foi utilizada para construir um modelo de regressão logística que identificasse variáveis com impacto no processo de detecção de atipias celulares. Foi aplicada uma curva ROC para definir o ponto de corte mais adequado para classificar a presença ou a ausência de atipias. Uma análise de sensibilidade foi realizada para avaliar o impacto dos fatores relacionados à organização do serviço no modelo. RESULTADOS: As variáveis preditoras do modelo foram: "laboratório de referência", que reflete a escala de produção do laboratório; "presença de elementos celulares representativos da zona de transformação", que reflete a qualidade da coleta de amostras; "metaplasia escamosa imatura", "presença de outras alterações celulares benignas" e "ausência de microrganismos da microbiota vaginal". A cada acréscimo de 1 ano na idade da mulher, houve redução de 1,7% na chance de detecção de atipias. A curva ROC definiu o ponto de corte de 4,5%, que permitiu a maximização da sensibilidade (73,0%) e especificidade (66,8%) do modelo. A análise de sensibilidade indicou aumento da frequência de atipias de 46,4% quando simulou-se aumento na participação do laboratório de referência (42,9%) e na presença de elementos celulares representativos da zona de transformação (43,0%). CONCLUSÕES: O modelo revelou que a detecção de atipias celulares é fortemente influenciado por fatores organizacionais, como adequabilidade da lâmina e porte do laboratório de análise. Considerando que esses fatores são passíveis de alteração pelos gestores, o modelo pode ser uma importante ferramenta na melhoria dos programas de rastreamento.

OBJECTIVE: To identify the main determinants of cellular atypia detection in the cervical screening program in the state of Rio de Janeiro, Brazil, using data from the Cervical Cancer Information System SISCOLO. METHODS: A random sample of 65 535 Pap smears performed in 2007 was obtained from SISCOLO. This sample was used to produce a logistic regression model to identify variables that impact the process of detecting cellular atypia. A ROC curve was used to define the most suitable cutoff point to classify the presence or absence of atypia. A sensitivity analysis was performed to assess the impact on the model of factors related to the organization of the service model. RESULTS: The variables of impact were "reference laboratory," which reflects laboratory production scale; "presence of cellular elements representative of the transformation zone," which reflects the quality of the sampling; "immature squamous metaplasia," "presence of other benign cellular changes," and "absence of typical vaginal microorganisms." Each increase of 1 year in age was associated with a 1.7% reduction in the chance of detecting atypia. The ROC curve defined a cutoff of 4.5%, which allowed the maximization of the model's sensitivity (73.0%) and specificity (66.8%). Sensitivity analysis indicated an increase of 46.4% in the frequency of atypia following a simulated increase in the number of samples analyzed in the excellence (42.9%) and in the presence of cellular elements representative of the transformation zone (43.0%). CONCLUSIONS: The model revealed that the detection of atypical cells is strongly influenced by organizational factors such as adequate sample collection and laboratory size. Because these factors can be changed by adequate management practices, the proposed model may be an important tool to improve cervical screening programs.

Human papillomavirus infection among sexual partners attending a Sexually Transmitted Disease Clinic in Rio de Janeiro, Brazil

Cervical cancer is a major source of illness and death among women worldwide and genital infection with oncogenic human papillomavirus (HPV) its principal cause. There is evidence of the influence of the male factor in the development of cervical neoplasia. Nevertheless, the pathogenic processes of HPV in men are still poorly understood. It has been observed that different HPV types can be found among couples. The objective of the present study was to investigate HPV infections in female patients (n = 60 females/group) as well as in their sexual partners and to identify the concordance of HPV genotypes among them. By using the polymerase chain reaction, we detected a 95% prevalence of HPV DNA in women with cervical intraepithelial neoplasia (CIN) compared to 18.3% in women with normal cervical epithelium, with a statistically significant difference (P < 0.001). The HPV DNA prevalence was 50% in male partners of women with CIN and 16.6% in partners of healthy women. In the control group (healthy women), only 9 couples were simultaneously infected with HPV, and only 22.2% of them had the same virus type, showing a weak agreement rate (kappa index = 0.2). Finally, we observed that HPV DNA was present in both partners in 30 couples if the women had CIN, and among them, 53.3% shared the same HPV type, showing moderate agreement, with a kappa index of 0.5. This finding supports the idea of circulation and recirculation of HPV among couples, perpetuating HPV in the sexually active population, rather than true recurrences of latent infections.

Neoplasia intraepitelial cervical de alto grado en mujeres menores de 25 años y mayores de 45 años / Cervical intraepithelial neoplasia of high degree in women younger than 25 and older than 45 years old

Evaluar las características de pacientes menores de 25 y mayores de 45 años con diagnóstico de neoplasia intraepitelial cervical II-III. Estudio retrospectivo, descriptivo y comparativo de 334 historias de neoplasia intraepitelial cervical II-III consultantes a la Maternidad "Concepción Palacios" entre 2005 y 2009, distribuidas en: 20,7 por ciento menores de 25 años (Grupo A), 64,8 por ciento entre 25-45 (Grupo B) y 14,4 por ciento mayores de 45 (Grupo C). En 23,1 por ciento la lesión era grado II y en 76,9 por ciento grado III. El inicio de la actividad sexual fue 15,5 ± 2, 16,9 ± 2,6 y 17,8 ± 3 años, respectivamente (P=0,001), el primer embarazo ocurrió a los 15, 19 y 20 años para cada grupo (P=0,001). El número de gestaciones fue 1, 2 y 4 respectivamente (P=0,01). Hubo 43,9 por ciento de fumadoras en el Grupo C (P=0,001) y 29,6 por ciento de pacientes inmunosuprimidas en el Grupo A (P< 0,05). Predominaron las alteraciones de las células epiteliales en la citología de los 3 grupos. No hubo diferencias en la colposcopia, la terapéutica utilizada ni en las tasas de curación, persistencia o recidiva. En el grupo A, 85,7 por ciento de las lesiones persistentes fueron lesiones de bajo grado (P< 0,05). Los factores de riesgo importantes en el grupo A fueron: inicio precoz de relaciones sexuales, primer embarazo temprano, número de gestaciones e inmunosupresión. En el grupo C fueron mayor paridad, tabaquismo, y mayor índice de masa corporal. La clínica, tratamiento y evolución fueron similares con 20 por ciento de persistencia y menos de 10 por ciento de recidivas

To assess the characteristics of patients under the age of 25 and over 45 years with diagnosis of cervical intraepithelial neoplasia II-III. Retrospective, descriptive and comparative study of 334 patients with cervical intraepithelial neoplasia II-III diagnostic consulting to Maternidad Concepcion Palacios, in 2005-2009, distributed in:20.7 percent under the age of 25 (Group A) 64.8 percent between 25-45 (Group B) and 14.4 percent over the age of 45 (Group C). El 23.1 percent had cervical intraepithelial neoplasia II and 76.9 percent cervical intraepithelial neoplasia III. The onset of sexual activity was 15.5 ± 2, 16.9 ± 2.6 and 17.8 ± 3 years, respectively (P=0.001), the first pregnancy occurred 15, 19 and 20 years for each group (P=0.001). The number of pregnancies was 1, 2 and 4 respectively (P=0.01). There was 43.9 percent of smokers in Group C (P=0,001) and 29.6 percent of patients who are immunosuppressed in Group A (P< 0,05). The disturbances of epithelial cells on cytologyof 3 groups were predominated. There were no differences in the colposcopy, therapeutic or in rates of healing, persistence or recurrence. In Group A, 85.7 percent of persistent injuries were low grade (P< 0.05). The more important risk factors in Group A were: early onset of sexual relations, early first pregnancy, number of pregnancies and immunosuppression. In Group C were: greater parity, smoking, and higher body mass index. The clinic, treatment and evolution were similar with 20 percent of persistence and less than 10 percent of relapses

Prevalence and risk factors for cervical intraepithelial neoplasia among HIV-infected women

OBJECTIVES: To evaluate the prevalence and the risk factors for cervical intraepithelial neoplasia (CIN) among HIV-infected women. METHODS: Cross-sectional study of 494 HIV-infected women in Brazil, between 1998 and 2008. Gynecologic exam was performed, and samples were collected for cervical cytology and for HPV DNA detection. Cervical biopsy was carried out when indicated. HPV infection, CD4 T-lymphocyte count and HIV viral load were compared with cervical histopathology. Univariate and multivariate statistical analyses were performed to evaluate the statistical association of several risk factors. RESULTS: CIN prevalence detected by histopathology was 23.4% (6% of CIN2/3 and 17.4% cases of CIN1). Multivariate analysis confirmed an independent association of CIN with CD4 T-lymphocyte count below 200 cells/mm³ (OR 5.0, 95% CI 2.5-10.1), with a positive detection of HPV DNA (OR 2.0, 95% CI 1.2-3.5), and with age < 34 years old (OR 1.5, 95% CI 1.0-2.4). HIV viral load and antiretroviral use were not independent risk factors for CIN. CONCLUSIONS: Severity of immunosupression, presence of HPV infection and younger age are strong predictors of CIN among HIV-infected women.

Presence of high-grade intraepithelial lesions among women deprived of their liberty: a documental study / Presença de lesões intraepiteliais de alto grau entre mulheres privadas de liberdade: estudo documental / Presencia de lesiones intraepiteliales de alto grado a las mujeres privadas de libertad: estudio documental

The aim of this study was to analyze the results of the Pap smears of women deprived of their liberty. It is a retrospective, documental study, with a quantitative approach, performed in a female prison of Ceará, Brazil, with a sample of 672 patient records. Regarding the microbiological findings, it was verified that the main cervical-vaginal colonization was by bacilli suggestive of Gardnerella/Mobiluncus (21.8%), followed by Trichomonas vaginalis (12%), and Candida sp (5.8%). The frequencies of samples with atypical cells presented rates of 4.1% for Atypical Cells of Undetermined Significance; 3.2% for Low-grade Intraepithelial Lesions; and 2.5% for High-grade Intraepithelial Lesions. The importance of screening for cervical cancer in female prisons was highlighted, as well as the inclusion of the nurse in this environment, ensuring individualized, quality care for women deprived of their liberty.

Objetivou-se analisar os resultados dos exames citopatológicos de mulheres privadas de liberdade. Estudo documental, retrospectivo, com abordagem quantitativa, desenvolvida em uma penitenciária feminina do Ceará, Brasil, com amostra de 672 prontuários. Quanto aos achados microbiológicos, foi verificado que a principal colonização cérvico-vaginal foram os bacilos sugestivos de Gardnerella/Mobiluncus com 21,8%, seguidos de Trichomonas vaginalis 12,% e Candida sp em 5,8%. As frequências de amostras com atipias celulares mostraram índices de 4,1% para atipias de significado indeterminado; lesões intraepiteliais de baixo grau 3,2% e lesões intraepiteliais de alto grau 2,5%. Conclui-se sobre a importância do rastreio do câncer cervical nos presídios femininos, bem como a inserção do enfermeiro nesse ambiente, garantindo cuidado individualizado e de qualidade para as mulheres privadas de liberdade.

El objetivo fue analizar los resultados de la prueba de Papanicolaou de mujeres privadas de libertad. Tipo de estudio documental, con un enfoque cuantitativo, desarrollado en una cárcel de mujeres en Ceará-Brasil, con muestra de 672 archivos. En cuanto a los resultados microbiológicos se comprobó que el principal colonización de cáncer cervical-vaginal fueron los Bacilos sugestivos de Gardnerella/Mobiluncus con 21,8%, seguido de Trichomonas vaginalis 12% y Cándida sp 5,8%. Las frecuencias de las muestras con atipia celular se registraron tasas de 4,1% para Atipias de significado indeterminado; Lesiones Intraepiteliales de bajo grado 3,2% y Lesiones Intraepiteliales de alto grado 2,5%. La conclusión es la importancia de la detección del cáncer cervical en las cárceles de mujeres, así como la inclusión de los enfermeros en este entorno al tiempo que garantiza una calidad y una atención individualizada a las mujeres presas.

Co-infections associated with human immunodeficiency virus type 1 in pregnant women from southern Brazil: high rate of intraepithelial cervical lesions

Human immunodeficiency virus type 1 (HIV-positive) pregnant women require specific prophylactic and therapeutic approaches. The efficacy of established approaches is further challenged by co-infection with other sexually transmitted diseases (STDs). The objective of this study was to determine the prevalence of co-infections in pregnant women infected with different HIV-1 subtypes and to relate these findings, together with additional demographic and clinical parameters, to maternal and infant outcomes. Blood samples from pregnant women were collected and tested for syphilis, hepatitis B virus (HBV) and hepatitis C virus (HCV). Human papillomavirus (HPV) diagnosis was evaluated by the presence of alterations in the cervical epithelium detected through a cytopathological exam. Medical charts provided patient data for the mothers and children. Statistical analyses were conducted with STATA 9.0. We found a prevalence of 10.8 percent for HCV, 2.3 percent for chronic HBV, 3.1 percent for syphilis and 40.8 percent for HPV. Of those co-infected with HPV, 52.9 percent presented high-grade intraepithelial lesions or in situ carcinoma. Prematurity, birth weight, Apgar 1' and 5' and Capurro scores were similar between co-infected and non-co-infected women. The presence of other STDs did not impact maternal and concept outcomes. More than half of the patients presenting cervical cytology abnormalities suggestive of HPV had high-grade squamous intraepithelial lesions or cervical cancer, evidencing an alarming rate of these lesions.

Circulation of human papillomavirus (HPV) genotypes in women from Córdoba, Argentina, with squamous intraepithelial lesions / Circulación de genotipos de virus papiloma humano (VPH) en mujeres con lesiones intrepiteliales escamosas de Córdoba, Argentina

Human papillomavirus (HPV) can induce a wide spectrum of squamous intraepithelial lesions (SIL) of varying severity. The aim of the present study was to establish the frequency of HPV infection and identify the genotypes circulating in women from Córdoba, Argentina, in relation to age and cytology. A total of 186 women, between 18 and 65 years old, with antecedents of SIL, underwent a pelvic examination and had cervical cells collected for cytology and HPV DNA detection. Ninety-six samples (51.6 percent) were positive for HPV detection, and sixty-three (65.6 percent) of them showed the presence of at least one HR-HPV. Low- and high-grade SIL showed significant association in patients younger than 35 years of age. We found 18 different genotypes, with a greater presence of HR-HPV. Genotypes 16 and 6 were the most frequent. Seven (7.3 percent) multiple infections, 85.7 percent of which had at least one HR-HPV, were detected. The detection of a large number of different HPV genotypes is a warning sign. It is thus necessary to strengthen the monitoring of the circulation of high-risk genotypes, currently less prevalent in intraepithelial lesions, as a control measure for the possible impact of the implementation of vaccines against genotypes 16 and 18.

El papilomavirus humano (human papilloma, HPV) induce un amplio espectro de lesiones intraepiteliales escamosas (SIL) de variada severidad. Objetivo: conocer la frecuencia de infección por HPV y determinar los genotipos circulantes en mujeres de la ciudad de Córdoba, Argentina, en relación con la edad y la citología. Se realizó citología y detección de ADN-HPV en células cervicales de 186 mujeres de 18 a 65 años con antecedentes de SIL. Noventa y seis (51.6 por ciento) fueron positivas para la detección del HPV, de las cuales, en 63 (65.6 por ciento) se detectó la presencia de al menos, un HPV de Alto Riesgo (HR-HPV). Las SIL de alto grado (HSIL) y de bajo grado (LSIL) se asociaron a pacientes menores de 35 años. Se hallaron 18 genotipos diferentes, con mayor presencia de HR-HPV. HPV 16 y 6 fueron más frecuentes y se detectaron 7 (7.3 por ciento) infecciones múltiples, 85.7 por ciento de éstas presentaron al menos un HR-HPV. La detección de un alto número de diferentes genotipos es una señal de alerta. Por tanto, es necesario fortalecer la vigilancia de los HR-HPV, actualmente menos frecuentes en las SIL, como medida de control del impacto que tendrá la implementación de las vacunas contra HPV 16 y 18.

Prevalencia de citología anormal e inflamación y su asociación con factores de riesgo para neoplasias del cuello uterino en el Cauca, Colombia / The prevalence of abnormal cytology and inflammation and their association with risk factors for uterine cervical neoplasms in Cauca, Colombia

Objetivos Establecer la prevalencia del resultado de citología anormal e inflamación y su asociación con factores de riesgo para neoplasias del cuello uterino en mujeres del departamento del Cauca, Colombia. Metodología Después de la Arma voluntaria del consentimiento informado, las mujeres fueron entrevistadas a través de un cuestionario para colectar variables de tipo sociodemográfico y clínico, incluyendo historia reproductiva, actividad sexual, historia de citología y hábito de fumar. Posteriormente, se procedió a la toma de la citología para su análisis y clasificación según el sistema Bethesda 2001. Un total de 1735 mujeres fueron reclutadas para este estudio. Resultados Acorde con el resultado de citología, 1061 mujeres presentaron citología normal (61 %), 36 citología anormal (2 %) y 638 cambios celulares reactivos asociados a inflamación (37 %). Los resultados indican que tener relaciones sexuales a temprana edad, la multiparidad, el uso de anticonceptivos hormonales y no realizarse la citología anualmente fueron factores de riesgo asociados a citología anormal. Conclusiones Estos resultados brindan información valiosa a las instituciones de salud pública para desarrollar mejores programas de cribado para la prevención de neoplasias del cuello uterino en mujeres de la región y el país.

Objectives Establishing the prevalence of abnormal and inflammation cytology reports and its association with risks factors for uterine cervical neoplasms amongst females from the Cauca department in Colombia. Methodology After signing a consent-form, females were interviewed using a questionnaire to collect socio-demographic and clinical data, including reproductive history, sexual activity, cytology history and smoking habits. Cytology was then taken for analysis and classification according to the 2001 Bethesda System. A total of 1,735 females were recruited for the study. Results According to the cytology report, 1061 women had normal cytology (61 %), 36 abnormal cytology (2 %) and 638 reactive cellular changes associated with inflammation (37 %). The results indicated that having sexual intercourse at an early age, multiparity, using hormonal contraceptives and not having annual cytology screening were associated with abnormal cytology reports. Conclusions These results provided valuable information for public health institutions for developing better screening programmes to prevent risks of uterine cervical neoplasms amongst females from our region and throughout Colombia.

Neoplasia intraepitelial cervical en un área de salud / Cervical intraepithelial neoplasia in a health area

INTRODUCCIÓN: El cáncer cérvicouterino es la segunda neoplasia maligna más frecuente en mujeres, cuya solución debe sustentarse en la aplicación de medidas organizativas, el conocimiento de la epidemiología de la afección y el perfeccionamiento de los métodos de detección temprana y tratamiento. OBJETIVOS: Determinar el comportamiento de factores de riesgo de neoplasia intraepitelial cervical en los estratos suburbano y rural de Santa Cruz del Norte. Identificar en los grupos caso y control el comportamiento de algunos factores en las áreas seleccionadas. Comparar el comportamiento de los factores seleccionados entre los estratos suburbano y rural. MÉTODOS: Se realizó un estudio analítico de casos y controles donde se incluyó una muestra constituida por 126 mujeres. Las variables estudiadas estuvieron relacionadas con la esfera sexual y conductual. Se evaluaron los factores de riesgo a través del odds ratio y el cálculo del Test chi-cuadrado. RESULTADOS: Los factores relacionados con los antecedentes de infecciones de transmisión sexual (OR= 3,1 y 9), y el tabaquismo (OR= 6,1 y 7,5) se comportaron como factores de riesgo para ambos estratos. El número de parejas sexuales, solo resultó factor de riesgo para las mujeres de la población suburbana (OR= 4,5). Las diferencias entre las pacientes de los estratos suburbano y rural fueron significativas en todos los factores analizados excepto para la de "el número de partos" (p< 0,05). CONCLUSIONES: Se evidenció que las infecciones de transmisión sexual, y el tabaquismo se comportaron como factores de riesgo para las poblaciones de ambos estratos, a diferencia del uso de anticonceptivos orales, la edad del primer parto, la paridad y el tipo de parto. El número de parejas sexuales, solo resultó factor de riesgo para las mujeres de la población suburbana

INTRODUCTION: The cervicouterine cancer is the second malignant neoplasia more frequent in women, whose solution must to be based in implementation of organizing measures, the knowledge of affection epidemiology and the improvement of early detection methods and of treatment. OBJECTIVES: To determine the behavior of risk factors related to cervical intraepithelial neoplasia in suburban and rural strata of Santa Cruz del Norte municipality. To identify in case-control groups the behavior of some factors in selected areas. To compare the behavior of factors selected among the suburban and rural strata. METHODS: A analytical study of case-controls was conducted including a sample of 126 women. The study variables were related to this sexual and behavioral sphere and the risk factors by odds ratio and the chi² test calculus were assessed. RESULTS: Factors related to a history of sexual transmitted infections (OR= 3.1 and 9) and smoking (OR= 6.1 and 7.5) were considered as risk factors for both sexes. The number of sexual partners only was a risk factor for the suburban female population (OR= 4.5). The differences among patients of suburban and rural strata were significant in all factors analyzed except for that related to the "number of labors" (p< 0.05). CONCLUSIONS: It was evidenced that the sexual transmission infections and smoking were considered as risk factors for populations of both strata unlike the use of oral contraceptives, age in the first labor, parity and the type of labor. The number of sexual partners only was considered a risk factor for the women from the suburban population

Lesões cervicais de baixo e alto grau em adolescentes soropositivas para o HIV / Low and high-grade cervical lesions among HIV-infected adolescents

Foi realizada uma revisão da literatura sobre a incidência de lesões intraepiteliais escamosas de baixo e de alto grau em adolescentes soropositivas para o HIV. Os estudos mostraram diferenças na incidência dessas lesões nas pacientes adultas soropositivas (13 a 30% de lesões intraepiteliais escamosas de baixo grau; 1 a 32,6% de alto grau), nas adolescentes com sorologia desconhecida para o HIV (5,7 a 20% de lesões intraepiteliais escamosas de baixo grau; 0 a 4,8% de alto grau) e nas adolescentes soropositivas para o HIV (19,5 a 55% de lesões intraepiteliais escamosas de baixo grau; 4,8 a 21,5% de alto grau). Comentou-se sobre as diferenças na positividade para o HPV em adolescentes HIV positivo e negativo. As recomendações atuais sobre o rastreamento do câncer cervical e a conduta nas alterações cervicais em adolescentes foram revistas

We performed a review of literature on the incidence of low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion in adolescents seropositive for the human immunodeficiency virus (HIV). The studies showed differences in the incidence of these lesions in seropositive adult patients (13 to 30% of low-grade squamous intraepithelial lesion; 1 to 32.6% of high-grade squamous intraepithelial lesion), in adolescents with unknown HIV serology (5.7 to 20% of low-grade scamous intraepithelial lesion; 0 to 4.8% of high-grade scamous intraepithelial lesion) and in adolescents seropositive for HIV (19.5 to 55% of low-grade squamous intraepithelial lesion; 4.8 to 21,5% of high-grade squamous intraepithelial lesion). We commented on the differences in positivity for the Human Papiloma Virus (HPV) in HIV positive and negative adolescents. Current recommendations on the screening of cervical cancer and management of cervical abnormalities in adolescents were reviewed