Estudo socioepidemiológico, clínico e de genotipagem do papilomavírus humano em mulheres com HIV/AIDS

Abstract

This study determined the cases of Human Papillomavirus (HPV) among women living with HIV / AIDS, as well as investigated the HPV genotypes present in the cervical mucosa of these women. A cross-sectional, descriptive study developed at the Meireles School Health Center with 50 women living with HIV / AIDS treated at the center, as well as those from other services to perform the uterine cervical cancer screening test. The data were collected through an interview that investigated epidemiological variables, sexual behavior and gynecological prevention, ectocervical and endocervical cytopathological data collection for the evaluation of Papanicolau and Molecular Test of Polymerase Chain Reaction (PCR) in order to identify fragments of viral DNA in the Nucleus and / or cytoplasm of infected cells. Descriptive analyzes were used for the analyzes through the frequency distributions (uni and bivariate) and descriptive measures (means, standard deviation and / or medians). To identify the factors associated with changes in precursor lesions of the cervix, tables of association between the dependent variable in question and the other independent variables were elaborated. Associations were checked by chi-square or Fisher exact test, when necessary. Odds Ratio (OR) and respective confidence intervals (95% CI) were determined to expose the strength of the association with the outcome. In all tests, a significance level of 0.05 (5%) was adopted, and a P value <0.05 was considered statistically significant. In the results, the majority of the women were aged ≥ 40 years (62.0%), average of eight years of study (62.0%), browns (52.0%), unemployed (74.0%), Of a minimum wage (74.0%), did not live with their partner (54.0%) and had children (78.0%). There was a predominance of the category of sexual exposure (92.0%) as a mode of HIV acquisition, heterosexual (92.0%), HIV diagnosis time in five years (46.0%), CD4 + (74.0%) and viral load lower than 50 copies / ml (94.0%) and the use of licit drugs such as alcohol and tobacco (66.0%). About preventive measures against cervical cancer most performed the exam at least once throughout life and the minority were immunized against HPV. Cytopathological results indicated that a significant percentage (66.0%) presented a positive result for the schiller test and some type of inflammation between mild, moderate and marked (90.0%). Three women (6.0%) had HPV test results and low grade intraepithelial lesion and one (2.0%) high grade intraepithelial lesion. There was a statistically significant association between the age of Coitarca and history of STI and between atypias of squamous cells and the use of condoms. Of the 50 women with HIV / AIDS who composed the sample, 44 were tested for HPV, identifying a negative HPV result in 30 (68.0%) women and a positive result in 14 (32.0%). Of the 14 women with a positive HPV test, 12 (86.0%) had subgroup A types considered high oncogenic risk, one (7.0%) presented only type 16 and one (7.0%) presented Type 16 and associated subgroup A. Four (100%) women identified with cervical intraepithelial lesions (ILE) also had HPV, three (6.0%) of them with low-grade cervical LV and high-risk HPV and one (2.0%) with High-grade cervical LIE and HPV 16. It is concluded that women with HIV are vulnerable to cytological alterations, among them cervical intraepithelial lesions and because they present HPV and among them oncogenic subtypes, it is demonstrated that women living with HIV / AIDS of the sample studied are at risk for the development of cervical cancer.