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Koilocytes, Papanicolaou, Endocervical, Dysplasia, CD4, CD8

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Koilocytes, Papanicolaou, Endocervical, Dysplasia, CD4, CD8 American Journal of Medicine and Medical Sciences 2012, 2(4): 75-79 DOI: 10.5923/j.ajmms.20120204.03 Correlation Between Koilocytes, HPV DNA and CD4 Cells Count in Male and Female HIV Cohorts Ajobiewe Olu Joseph1,*, Isu Nnena Rosemary1, Agwale Simon2 1University of Abuja, Department of Biological Sciences, Faculty of Natural Sciences, PMB 117, Gwagwalada, Federal Capital Territory (F.C.T.) Abuja Nigeria 2Innovative biotechnology Inc3516,Langrehr Road, Suite 2A, Windsor M.ill. MD 21244, USA Abstract The study x-rays the relationship between Koilocytes and [Cluster of Differentiation]CD4 Count from HIV positive unisex cohorts aged 15 -40 years and above. The cohorts, were randomly tested for the presence of koilocytes, using their semen and endocervical swab samples respectively at some top Hospitals in Abuja, F.C.T. Nigeria. Their blood samples were tested for CD4 count. Papanicolaou staining technique was adopted-for demonstrating koilocytes. Results showed that, high koilocytes count of 39.0% and low CD4 Count of 350 lymphocyte counts /µl were observed; and low monthly mean koilocytes count of 7.60% and high CD4 Count of 687 lymphocytes counts/ µl were observed in the female and male cohorts respectively. High monthly prevalence count of koilocytes and low CD4 Count in the female cohorts and verse versa in the male cohorts were significantly correlated (P<0.05). Depression of immunity, is worsen in HPV and HIV co- infectivity. Keywords Koilocytes, Papanicolaou, Endocervical, Dysplasia, CD4, CD8 immunocompromised patients had decreased plasma and 1. Study Background Langerhans cells in the cervix, but increased T cells. In ad- dition there was inversion of the CD4: CD8 ratio inde- HPV does not disseminate and thus the local cervical pendent of the systemic CD4 counts. Infiltrating CD4 + immune response is a crucial factor in HPV replication. ( T-helper cells ) and CD8+(Cytotoxic /suppressor T cells ) Components of the local immune system include the lym- are found in regressing warts. It is postulated that loss of the phocytes, both CD4 and CD8 cytotoxic cells, and the CD4 + T- helper cells may mean that the local CD8 T cells Langerhans antigen-presenting cells. Spontaneous or treat- are ineffective in bringing about regression. 3 Women with ment induced regression of cervical dysplasia is probably HIV have a low incidence of invasive cervical cancer (ICC) mediated by the cell mediated immune system, particularly despite a high prevalence of risk factors.4 This was revealed T- helper type 1(Th1) lymphocytes and macrophages. Thus by a study that involved 2,131 ladies participating in the it seems likely that suppression of the immune response Women’s interagency HIV Study (1661 HIV-positive, 462 would worsen the natural course. Both HIV and HPV affect HIV-negative, and eight who seroconverted during the ob- the immune system. Cell mediated immunity is important in servation period). At study entry, 62.7% of the HIV-positive controlling HPV infection. CD8 Cells are increased in 1 women and 31.7% of the HIV-negative women had evidence Squamous Intraepithelial lesions (SIL). , A significantly of HPV infection; 13.6% and 3.6% respectively, had onco- greater number of lymphocytes in SIL lesions of HIV posi- 2 genic HPV strains associated with cervical cancer. At base- tive patients had been documented , none of whom had line, 37.7% of the HPV positive women and 17.3% of the AIDS. Not only was there an increased number of lympho- HIV negative women had abnormal cervical cytology. One cytes, but these were within the epithelial squamous cells as HIV-positive woman had cervical cancer at study entry. opposed to their sub epithelial location. Despite increased After 2,375 person-years of observation, no new cases of numbers, there was an inverse CD4 : CD8 ratio, and it was ICC were detected in the HIV- negative women. After 8,260 hypothesized that the CD4 T cells may be in effective in 2 person-years, eight potential new cases were identified in the activating the recruited CD8 cytotoxic T cells. Systemic and HIV- positive women, but only one was confirmed as ICC. 4 Cervical lymphocytes were both analysed in HIV and HPV The incidence rate of ICC among HIV-positive women, positive and negative controls, and it was found that was thus 1.2 per 10,000 person-years (95% confidence in- terval,0.3- 6.7 cases). There was no significant difference in * Corresponding author: ICC incidence between the HIV-infected and uninfected [email protected] (Ajobiewe Olu Joseph) 4 Published online at http://journal.sapub.org/ajmms women (P=1.0). In another paper, 223 women (202 Copyright © 2012 Scientific & Academic Publishing. All Rights Reserved HIV-positive and 21 HIV-negative) with CTN grade 1 for a Ajobiewe Olu Joseph et al.: Correlation Between Koilocytes, HPV DNA and CD4 76 Cells Count in Male and Female HIV Cohorts mean of 3.3 person-years were followed up.5 Progression High grade SIL occurred in 6% and 2% of the occurred in 8 HIV-positive women (1.2 per 100 person-years; HIV-infected and uninfected women respectively. Lower 95% CI 0.5-2.4) and 0-14 HIV-negative women. Regression CD4 count and higher viral load were associated with ab- occurred in 66 HIV-positive women (13 per 100 per- normal anal smear in HIV-infected women. Multivariate son-years) and 14 HIV-negative women (32 per 100 per- analysis showed that a history of anal intercourse and ab- son-years; P<0.001). Regression was associated with HPV normal cervical smear were significantly associated with risk detection and Hispanics ethnicity5. of an abnormal anal Pap smear.11 A prospective study of the natural history of HPV infec- Similar studies on 251 HIV-positive women and 68 HIV tion in 1,797 HIV- positive and 496 ‘at risk’ women showed —negative women for the presence of anal HPV revealed that HIV-positive women were 3 times more likely to be that 76% of HIV-positive and 42% of HIV negative women infected with HPV than HIV -ve women (OR1.33, P = 0.003) were found to have anal HPV DNA (relative risk [RR] 1.8). in particular type 18 (OR 2.45,p= 0.001) but not type 16 (OR 11 200 women had concurrent anal and cervical HPV data 1.44, P = 0.47). They were also more likely to contract HPV which showed anal HPV was more common than cervical type 16 during the 3 years of follow-up (P = 0.002). HPV HPV in both HIV-positive (79%vs53%) and HIV negative infection was more likely to persist in HIV positive women women (43%vs24%). Multivariate analysis indicated that a than HIV-negative women (OR 5.63, P=0.02). 6 HPV infec- CD4 count below 200cells/mm3 compared with a count tion was more likely to persist in HIV- positive than above 500,and cervical HPV infection were associated with HIV-negative women (OR 5.63, P=0.001) and in smokers anal HPV infection. 11 than non-smokers (OR 1.39, P = 0.02). 6 HPV infection was 480 women were screened for HIV, sexually transmitted measured in 222 HIV-positive and in 112 HIV-negative girls diseases, and cervical dysplasia. Among the 12% with HIV, aged 13-18 years.7 Rates of new infections were similar low-grade SIL prevalence was 10% and high grade SIL was between the 2 groups, but the HIV-positive girls were more 17%. In comparison, low and high grade SIL prevalence was likely to be infected with high-risk HPV types (4l vs.22%, 6.4% and 4% among HIV-negative women. These results P=0.003), which may be due to their greater experience of were statistically significant. 11 high-risk sexual behaviour, younger age at first sexual in- 102 women with cervical cancer and 102 cancer-free tercourse and greater number of sexual partners.7 controls were compared. Among women under 40 years, The HIV-positive girls took longer to clear HPV (mean cervical cancer was more common in women with HIV 689 vs. 403 days), including both low-and high-risk types. (30.8%) compared with controls (10.6%). Among the For every 100 cells/mm3 rise in CD4 cell count, there was a women with cervical cancer, the age of the HIV infected 6% unincrease in the likelihood of HPV clearance (p=0.015). women was lower (37 years) compared with HIV-negative Cytological examination of the cervix in 172 HIV-positive women (48 years). 12 and 84 HIV-negative girls aged 13-18 years, every month for The same investigator also conducted a prospective co- a median of 3 years revealed that none of the girls had high hort study of 328 HIV infected women and 325 uninfected grade SIL at baseline, but 22% of the HIV-positive and 5% women with no evidence of SILs by Pap smear and colpo- of the HIV-negative girls developed high grade SIL.8 High scopy at baseline. Over 30 months of follow-up, 20% of HIV concentrations of interleukin-12 were seen in the cervical infected women and 5% of the uninfected women developed mucus of girls progressing to high grade SIL. Low grade SIL a SIL (P<0.001)). Low grade SILs were detected among 91% and use of hormonal contraceptives were also associated of the infected women with SIL and 75% of the uninfected with progression. 9 -- this was from a study of over 1000 women with SIL. 12 120 patients with cervical cancer were Rwandan women including 365 HIV- positive women. At screened in Nigeria for HIV before and after radiotherapy.
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