Correlação entre status do microbioma vaginal e lesões precursoras do colo uterino e canal anal de mulheres HIV+ em uso de TARV com e sem o uso de inibidores da protease

Abstract

Immunodeficiency related to the human immunodeficiency virus (HIV) is known for its adverse impact in the natural history of human papillomavirus (HPV); it is associated with the rise in acquisition and persistence of induced HPV infection. The highly active antiretroviral therapy (HAART) allowed both quality and life expectancy of people living with HIV to increase. Protease inhibitors (PI) can cause adverse effects on mucosa, impacting on growth and tissue integrity, but tend to reach low concentrations in biological fluids. The objective of this research was to establish possible differences in the composition of the vaginal microbiome and the frequency of cervical and anal precursor lesions in HIV+ women on HAART, with and without PI. Eighty-eight women with HIV infection were divided into two groups: HAART with or without PI. All participants were submitted to anamnesis and clinical and sociodemographic data were collected. The total DNA, used as a model on the trials/tests based on the polymerase chain reaction for detecting of HPV DNA, was extracted from cervical and anal samples. Ectocervical, endocervical, and anal samples were collected for colpocytology and anal cytology. There was no difference between the groups with and without PI in relation to injuries related to HPV. Though there's a predominance of bacterial vaginosis (VB) in group PI (33.96% vs 17.14%), the difference was not so substantial when all the women were considering (p = 0.066). When women with a detectable viral charge and cell count T CD4 + <200 were excluded from both groups, the VB was more prevalent in group PI (p = 0,049). No associations were found between VB and age, use of preservatives, cervical HPV, time with the current HAART regimen, unprotected receptive anal intercourse, and cervical HPV-related injuries. The positivity rates for cervical and anal HPV were 35.21% and 78.8%, respectively. The presence of HPV-related lesions in colpocytology was associated with the anal positivity of HPV (p = 0.027). The proportion between HPV-related cervical infection and HPV-related cervical lesions was 2.5. The ratio between anal HPV infection and anal HPV-related injuries was 4.3. Thirty percent had concomitant HPV DNA in the cervix and anus. There were no differences in the frequency of cervical and anus-related HPV lesions, as well as in the occurrence of cervical and anal HPV infections among HIV+ women with and without PI. After excluding women with detectable viral load and CD4+ <200 T-cell counts, the occurrence of bacterial vaginosis in HIV+ women with PI increased.