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Editor,—The penitentiary centres in Spain harbour inmates in whom the combination of HIV infection, history of injecting drug use, and prostitution is common.1 Extensive protocols to detect sexually transmitted diseases and tuberculosis are implemented in these centres; however, human papillomavirus (HPV) infections and related lesions are not routinely searched for. Although Spain is characterised by a very low incidence of cervical cancer,2 a high rate of cervical cancer has been reported recently among the AIDS female population in Catalonia.3 We carried out a study aiming to characterise HPV cervical infection and related cervical lesions among women with many potential risk factors for cervical neoplasia. The study was done in the only institution in Barcelona where women are imprisoned. The population consisted of 157 women attending the medical office of the prison between February and December 1996 and represented 90% of all women staying in prison for more than 3 days. Women who agreed to participate underwent a gynaecological examination, collection of cervical cells, a structured interview by a trained nurse, determination of HIV, hepatitis B and C serostatus, and detection of HPV DNA in the cervical cells by means of PCR. L1 consensus primers MY09/MY11 were used with modifications as described by Hidelsheim et al.4
HPV DNA was detected in 48% of the women. The prevalence of cervical abnormalities was 29.9%; 19 women had a atypical squamous cells of undetermined significance (ASCUS) and 28 women were diagnosed with squamous intraepithelial lesion (SIL), five of whom had a high grade lesion. All women with a SIL and 42% of those with a ASCUS were HPV positive. Prostitution was reported by 38.2% and injecting drug use by 64.3% women. HIV infection was detected in 56.1%. HPV detection was significantly related to HIV, to injecting drug use, to prostitution practices, and to hepatitis C positive serology. After adjusting for these variables, HPV detection remained significantly associated with HIV and with length of time injecting drugs (table 1). No association between HPV detection was found with other reproductive and sexual characteristics. In addition, HIV positive women had an increased risk to develop SIL compared with HIV negative women (POR=5.02, 95% CI=1.69–14.89). As previously reported, the risk for SIL increased with low CD4 T cell counts, although POR did not reach statistical significance.5
Data from an ongoing study in a nearby area indicate that the prevalence of cervical abnormalities in the general population is around 4% (manuscript in preparation). This is the first time that we have documented in Spain a group of women with a very high rate of HPV infection linked to injecting drug use and with a rate of pre-neoplastic cervical lesions about seven times higher than that observed in the general population.
While in prison these women were appropriately treated for HIV infection and for SIL. When out of prison or in jail, a gynaecological screening every 6–12 months should be organised and recommended.
Financial support: This work has been partially supported by the Spanish Ministry of Health, FIS No 98/0646.
We thank Mrs Anna Coma for her assistance with data managing and analysis.
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