September 21, 2001
This study concludes that the cervix is a very vulnerable area to infection, possibly more than the surface of the vagina. The top layer of cells covering the cervix is thinner and more fragile, allowing them to be subject to crumbling, than that of the vagina, and the cervix is the location that receptors required for HIV infection are concentrated. Additionally, a cervical barrier can prevent virus particles from being transported into the fallopian tubes and peritoneal cavity by uterine contractions.
Although no one knows whether the diaphragm in conjunction with a microbicide is as effective as a condom in preventing HIV transmission, this report suggests new options for researchers to begin asking the question.
Source: AIDS 2001;15:1595-1602.
A study looked at the effect of HAART on high-risk human papillomavirus infections and related cervical lesions by prospectively evaluating virologic and cytologic markers of HPV infection in 163 HIV-infected women. Twenty-seven of the women were untreated, 62 were being treated with reverse transcriptase inhibitors, and 74 were being treated with HAART. The researchers report that 65% of the 163 women had evidence of HPV infection at baseline. Treatment with HAART seemed to have no demonstrable effect on the persistence of high risk HPV or evolution of lesions.
After adjustment for gynecologic therapy, the only variable significantly associated with the persistence of HPV infection was a CD4 cell count The results seemed to indicate that HPV cervical infection and related disease persist in a high proportion of women receiving HAART, particularly those with the longest history of HIV infection (long-term survivors), and suggest that, regardless of antiretroviral regimen and its effect on HIV replication, the number of CD4 cells remains a strong marker for survival.
The study found a significant reduction in the incidence of new HPV-16 and HPV-18 infections in women treated with HAART, compared with untreated and reverse transcriptase-treated women (p = 0.043). "This may suggest that the immune recovery induced by HAART can (in patients with higher CD4 cell counts) duplicate that found in the general population (i.e., early treatment results in regression of acute HPV infections at higher risk for evolution but in less effect on well-established or advanced HPV disease)," states the authors.
The recommendation eluded from this article indicates that all HIV-infected women should be routinely monitored for the emergence of high-grade cervical lesions and cervical cancer.
Source: J Infect Dis 2001;184:547-551.