High prevalence of cervical squamous cell abnormalities among HIV-infected women with immunological AIDS-defining illnesses

Abstract

Aim: To assess the results of Pap smear at postpartum scheduled visit, especially the prevalence of squamous cell abnormalities including association with CD4+ T-lymphocyte count (CD4+ count) levels at delivery among HIV-infected women between the years 1996 and 2004. Methods: As part of the research and implementation programs of short course antiretroviral regimens for the prevention of mother to child perinatal HIV transmission in HIV-infected pregnant women delivered at Siriraj hospital, CD4+ count at delivery and Pap smear at postpartum were evaluated. Results: Among 636 women, 13.3% had squamous cell abnormalities. Seventy-seven cases (90.6%) of squamous cell abnormalities were low grade squamous intraepithelial lesions. The prevalence of squamous epithelial cell abnormalities detected by Pap smear, was higher in women whose CD4+ count at delivery was <200 cells/μL than in women whose CD4+ count at delivery was ≥200 cells/μL, with a significant difference (21.2%vs 12.2%). Conclusions: All HIV-infected pregnant women should be evaluated for clinical and immunological status during the antepartum period. Pelvic examination and Pap smear should be considered as a part of this evaluation. They should receive comprehensive health-care services that continue after pregnancy, including postpartum gynecologic examination and Pap smear. Women with normal cervical cytological findings but low CD4+ count should be offered an antenatal Pap smear and long-term follow-up including a 6-monthly Pap smear. © 2006 Japan Society of Obstetrics and Gynecology.