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The relationship between menopausal women infected with the human immunodeficiency virus and cervical atrophy: A cytologic study
Author(s) -
Davies Gillian,
Firnhaber Cynthia,
Pantanowitz Liron,
Michelow Pamela
Publication year - 2019
Publication title -
diagnostic cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.417
H-Index - 65
eISSN - 1097-0339
pISSN - 8755-1039
DOI - 10.1002/dc.24092
Subject(s) - medicine , cart , menopause , atrophy , gynecology , human immunodeficiency virus (hiv) , obstetrics , physiology , immunology , mechanical engineering , engineering
Background With the advent of combined antiretroviral therapy (cART), HIV positive women are expected to live longer. The effect of chronic HIV infection and cART on cervical epithelial maturation has not been well studied in postmenopausal woman. The objective of this study was to determine whether HIV positive postmenopausal women on cART show expected atrophic changes in cervical Pap tests. Methods The maturation index (MI) was performed on routine cervical smears from HIV‐infected, postmenopausal women attending an HIV clinic in a tertiary hospital in Johannesburg, over a 4‐year period from January 2009 to December 2012. Results In Pap smears of 111 patients on cART, 58 (52%) showed an unexpected predominantly mature squamous epithelial pattern whereas 53 (48%) were predominantly immature or atrophic ( P = .0001). There was no significant statistical difference in maturation according to cART use. Conclusion HIV‐infected, postmenopausal women in this study had reduced rates of cervical atrophy than expected, irrespective of cART use and CD4 count. Initiation of cART before menopause was associated with greater cervical epithelium maturation than those women who started cART after menopause. Additional, larger studies are required to confirm this novel finding and to investigate the reason for this phenomenon.