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)

Distribution and risk of human papillomavirus in cervical lesions / 中国实用妇科与产科杂志

OBJECTIVE: To analyze the distribution and pathogenicity of 27 HPV(Human papillomavirus)subtypes in cervical lesions.METHODS: A retrospective analysis was carried out in 5735 patients with cervical lesions admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2015 to July 2017,including 997 cases of cervicitis,1568 cases of LSIL(low-grade squamous intraepithelial lesion),2576 cases of HSIL(high-grade squamous intraepithelial lesion)and 594 cases of cervical cancer. The HPV subtypes,histopathological results and ages were obtained for analysis.RESULTS: The positive rates of HPV in cervicitis group,LSIL,HSIL group and cervical cancer group were 57.0%,78.3%,90.5%,and 93.9%(P<0.05)respectively. The five most prevalent HPV types in cervicitis and LSIL group were 52,53,16,58 and 18;in HSIL and cervical cancer they were 16,52,58,33 and 18. The cumulative attribution rates of HPV16,18,58,52,33,31 and 45 in cervicitis,LSIL,HSIL and cervical cancer were 22.2%,38.4%,68.4% and 80.1%,respectively. The incidence of cervical cancer after HPV16,31 and 45 infection was 27.7,14.3 and8.2 times higher than that of cervicitis. Among the 36 cervical cancer tissue samples with negative HPV,8 cases were detected positive by HPV E6/E7 DNA detection.CONCLUSION: HPV16,18,58,52,33,31 and 45 have a high prevalence,cumulative attribution rates and risk values in patients with squamous intraepithelial lesions and cervical cancer. The above-mentioned subtypes of HPV should be included in the prevention and screening of cervical cancer.HPV E6/E7 DNA detection may be a reliable assay for HPV-based screening for prevention of cervical cancer.

Controversia en el tratamiento de la lesión intraepitelial escamosa de alto grado (NIC II) / Controversy in the treatment of high-grade squamous intraepithelial lesion (CIN II)

Contexto: el cono LLETZ actualmente es el tratamiento de las NIC de alto grado. La resistencia al procedimiento es argumentada por los efectos del sobretratamiento (estenosis e insuficiencia cervical), sobre todo cuando se utilizan métodos ablativos destructivos en lugar de la resección quirúrgica ambulatoria (LLETZ). Objetivo: analizar el diagnóstico y tratamiento del NIC II mediante cono y legrado en pacientes que acuden al servicio de Patología del tracto genital inferior del Hospital Oncológico SOLCA-Quito Ecuador. Sujetos y métodos: en este estudio epidemiológico descriptivo observacional de corte transversal se analizaron expediente clínicos de 820 pacientes con diagnóstico histopatológico por biopsia de NIC II; mujeres entre 17 a 82 años que acudieron al servicio de patología del tracto genital inferior sujetas a control, en estas pacientes se realizó 530 legrados. El estudio fue realizado en el Hospital Oncológico SOLCA de Quito Ecuador, de los años 2004 a 2013. Resultados: la histopatología de los conos libres de neoplasia representa el 98,66% (n=809); existen 11 casos de neoplasias residuales (1,34%). El 53,7% de casos presenta una lesión igual o mayor que en biopsia, lo que justifica el cono. Conclusión: el procedimiento de cono LLETZ tiene gran utilidad diagnóstica, terapéutica y pronóstica en mujeres que presentan NIC II y otras patologías similares. (AU)

Background: the LLETZ cone is currently the treatment of high grade NICs. The resistance to the procedure is argued by the effects of overtreatment (stenosis and cervical insufficiency), especially when destructive ablative methods are used instead of ambulatory surgical resection (LLETZ). Objective: to analyze the diagnosis and treatment of CIN II by means of cone and curettage in patients attending the pathology department of the lower genital tract of the SOLCA-Quito Ecuador Oncology Hospital. Subjects and methods: in this cross-sectional descriptive epidemiological observational study, we analyzed clinical records of 820 patients with histopathological diagnosis by CIN II biopsy; women between 17 and 82 years old who visited the pathology service of the lower genital tract subject to control, in these patients 530 catheters were performed. The study was conducted at the SOLCA Oncology Hospital of Quito, Ecuador, from 2004 to 2013. Results: the histopathology of neoplasm-free cones represents 98.66% (n = 809); there are 11 cases of residual neoplasms (1.34%). 53.7% of cases present a lesion equal to or greater than in biopsy, which justifies the cone.(AU)

Expressão das moléculas HLA-E nas lesões intraepiteliais cervicais em mulheres portadoras do HPV com ou sem a infecção pelo HIV-1 / HLA-E molecules expression in cervical intraepithelial lesions of HIV-1 infected and non-infected women

Entre mulheres com HIV/AIDS há um maior número de casos de infecções persistentes pelo HPV contribuindo para um risco aumentado do desenvolvimento de lesões intraepiteliais escamosas cervicais. Ademais, a expressão anormal de moléculas HLA-E pode modular o sistema imunológico através da ligação com o receptor inibitório (CD94/NKG2A) ou estimulatório (CD94/NKG2C) de células NK e linfóticos T CD8+, diminuindo imunovigilância favorecendo a evasão de céulas infectadas por vírus. Diante da escassez de estudos avaliando a molécula HLA-E na interação com o HPV, mais especificamente na infecção pelo HIV-1, este estudo teve como objetivo avaliar a expressão de HLA-E em lesões intraepiteliais cervicais em mulheres portadoras do HPV, apresentando ou não a infecção pelo HIV-1. Trata-se de um estudo transversal, ao qual foram submetidos ao processo imunohistoquímico tecido do colo do útero parafinado de 67 mulheres infectadas pelo HIV-1 e 62 mulheres não infectadas, todas com lesão intraepitelial cervical com HPV, o qual foi tipificado. A expressão da molécula HLA-E foi analisada quantitativamente como sem expressão, de 1% a 30%, de 31% a 70% e de 71% a 100%. Os resultados mostraram que a infecção por herpes vírus foi maior entre as participantes HIV+ (P=0,005). Na análise imunohistoquímica, ficou evidente que as lesões intraepiteliais cervicais de mulheres infectadas pelo HIV-1 apresentaram redução na expressão da molécula HLA-E de 31% a 100% em comparação com mulheres sem a infecção pelo HIV- 1 (P=0,001), sugerindo que essa redução possa ser um mecanismo de escape viral, que acarreta a redução da apresentação de peptídeos virais para os linfócitos T CD8+. A expressão do HLA-E não foi associada aos graus de lesões intraepiteliais cervicais. Outros estudos são necessários para melhor compreensão do padrão e da função da expressão das moléculas HLA-E em lesões intraepiteliais cervicais de mulheres infectadas pelo HIV- 1

Among women with HIV / AIDS there is a greater number of cases of persistent HPV infections contributing to an increased risk of developing squamous intraepithelial lesions of the cervix. In addition, abnormal expression of HLA-E molecules can modulate the immune system by binding to the inhibitory (CD94 / NKG2A) or stimulatory (CD94 / NKG2C) receptor NK cells and CD8+ T lymphocytes, decreasing immunovigilance and favoring the evasion of infected cells infected with virus. Due to the lack of studies evaluating the HLA-E molecule in the interaction with HPV, more specifically in HIV-1 infection, this project aimed to evaluate the expression of HLA-E in cervical intraepithelial lesions of infected women or not by HIV- 1, with the infection by HPV. It is a cross-sectional study, which was submitted to immunohistochemical processing the paraffin-embedded cervix tissue of 67 HIV-1 women infected with HIV-1 and 62 uninfected women, all of them with cervical intraepithelial lesion with HPV, which was typified. The expression of HLA-E was quantitatively analyzed as non- expressed, 1% to 30%, 31% to 70% and 71% to 100%. The results showed that the herpes virus infection was higher among HIV + participants (P = 0.005). In immunohistochemical analysis, it became evident that cervical intraepithelial lesions in HIV-1 infected women showed a reduction the expression of HLA-E molecule from 31% to 100% compared to women without HIV-1 infection (P = 0.001) Suggesting that this reduction may be a viral escape mechanism, which leads to a reduction in the presentation of viral peptides to CD8+ T lymphocytes. The expression of HLA-E was not associated with cervical intraepithelial lesions. More studies are need to better understand the pattern and function of HLA-E molecule expression in cervical intraepithelial lesions of infected women by HIV-1

Comportamiento de las lesiones intraepiteliales de alto grado en la consulta de patología de cuello / Behavior of high-grade intraepithelial lesions on the Cervix Pathology Consultation

Introducción: el cáncer cérvicouterino (CCU) es la segunda neoplasia maligna más frecuente en mujeres. Objetivo: determinar el comportamiento de las lesiones intraepiteliales cervicales de alto grado. Métodos: se realizó una investigación cuantitativa y cualitativa de tipo descriptivo transversal de las pacientes atendidas en la consulta de patología de cuello del Hospital Universitario "Mártires del 9 de Abril" de Sagua la Grande, en el período comprendido entre enero y diciembre de 2011. El universo estuvo constituido por 158 mujeres que asistieron a consulta con citología alterada, la muestra fue de 70 mujeres con diagnóstico de lesión de alto grado. Se revisaron las historias clínicas, tarjetas de citodiagnóstico y se entrevistaron las pacientes, se confeccionó la base de datos. Resultados: la edad más frecuente fue 25-44 años. El 67,1 % inició su vida sexual entre los 16 y 20 años. Existió una relación directa entre la infección por el VPH y la aparición de las lesiones intraepiteliales cervicales, dado que en 53 pacientes (72,6 %) existió el hallazgo citológico del VPH. Hubo una correspondencia adecuada entre los resultados de la biopsia por ponchamiento y la biopsia por cono. En cuanto al tratamiento definitivo, a 53 pacientes se les realizó cono por bisturí frío y solo a 9 histerectomía total. Conclusiones: una de cada 10 pacientes afectada por una lesión de alto riesgo es menor de 25 años. A mayor tiempo transcurrido desde el inicio de las relaciones sexuales se incrementa la aparición de lesiones de alto grado.

Introduction: cervical cancer (CCU) is the second most common malignancy in women. Objective: to determine the behavior of high grade cervical intraepithelial lesions. Methods: a quantitative and qualitative cross descriptive study was conducted in patients treated in the cervix pathology service at the University Hospital Mártires del 9 de Abril , Sagua la Grande, from January to December 2011. The universe of our study consisted of 158 women who were assisted at consultation with abnormal cytology; the sample was 70 women diagnosed with high-grade lesion. We reviewed the medical records, greeting cytodiagnosis and interviewed the patients. Data were entered in a database. Results: the most common age was 25-44 years. 67.1 % started their sexual life between 16-20 years old. There was a direct relationship between HPV infection and the development of cervical intraepithelial lesions, since 53 patients (72.6 %) showed HPV cytologic finding. There was a suitable correspondence between the results of punch biopsy and cone biopsy. As for the definitive treatment, 53 patients underwent cold blade cone and only 9 underwent total hysterectomy. Conclusions: one in 10 patients affected by high-risk injury is younger than 25 years. A longer time since the onset of sexual intercourse increases the appearance of high-grade lesions.

Lesiones intraepiteliales cervicales de bajo grado. Regresión, persistencia y progresión a los dos años de evolución / Low degree cervical intraepithelial lesions. Regression, persistence, and progression after two years of evolution

Muchos investigadores, afirman que la mayor parte de los cánceres escamosos del cérvix se originan a partir de las neoplasias intraepiteliales cervicales (NIC). Un metaanálisis informó que los NIC I tienen una incidencia media global de progresión a carcinoma in situ del 11 por ciento y de 1 por ciento hacia cáncer invasivo. En los últimos años, la conducta expectante ha sido adoptada en concordancia con las publicaciones, que señalan poca progresión o hasta normalización de estas lesiones. OBJETIVOS: evaluar el comportamiento evolutivo de las NIC I y conocer algunos factores clínicos y sociodemográficos de las pacientes con estas lesiones. MÉTODOS: se realizó un estudio prospectivo observacional, en el servicio de Ginecología del Centro de Investigaciones Médico Quirúrgicas en 55 mujeres diagnosticadas como NIC I entre los meses de enero de 1994 y diciembre 1995. RESULTADOS: el 74,6 por ciento tenía entre 25 y 39 años. El 80 por ciento tuvo su primera relación sexual antes de los 20 años. El tabaquismo fue referido por el 12,7 por ciento. El uso de anticoncepción hormonal fue del 14,5 por ciento. A los dos años de evolución: las citologías fueron negativas en el 72,7 por ciento, persistió NIC I en el 10,9 por ciento y el 9,1 por ciento tuvo progresión de la enfermedad en este período. CONCLUSIONES: la NIC I fue más frecuente en mujeres en la etapa reproductiva y las que comenzaron su vida sexual antes de los 20 años. La regresión de las lesiones se observó en algo más de 7 de cada 10 mujeres, persistió en casi 2 de cada 10 y la progresión de la enfermedad en1 una de cada 10.

Many researchers confirm that the cervical scamous cancers are caused by cervical intraepithelial neoplasms (CIN). A meta-analysis reported that CIN I have a global mean incidence of progression to in situ carcinoma of 11 percent and of 19 percent to invasive cancer. In past years, expected behavior has been adopted in concordance with publications signaling little progression or up a normalization of these lesions. AIMS: To assess the evolutionary behavior of the CINs I and also to know some clinical and sociodemographic factors of patients presenting these lesions. METHODS: An observational and prospective study was carried out in Genecology Service of Medical Surgical Research Center in 55 women diagnosed with CIN I from January,1994 to December, 1995. RESULTS: The 74,6 percent had between 25 and 39 years old. The 80 percent had its first sexual intercourse before 20 years old. Smoking was referred by the 12,7 percent. Use of hormonal contraceptives was of 14,5 percent. At two years of course: cytology tests were negative in 72,7 percent, CINs I persisted in 10,9 percent, and 9,1 percent had a disease progression at this stage. CONCLUSIONS: CIN I was the more frequent entity in women in reproductive age, and those having its sexual life before 20 years old. Lesions regression was present in more than 7 of each 10 women, persisting in almost 2 of each 10, and disease progression in 1 of each 10.