18, 95% CI: 1.01–4.69). Any ectopy age-adjusted HR: 1.54, 95% CI: 0.61–3.89 >20% ectopy age-adjusted HR: 3.26, 95% CI: 0.44–23.85 However, other observational studies have not found an association between cervical ectopy and HIV infection. A cross-sectional
study conducted among 730 serodiscordant Italian couples did not find a significant association between cervical ectopy and a heightened risk of HIV infection (OR: 1.7, 95% CI: 0.4–7.2). In a study Selleck MI-503 conducted among 189 HIV-infected and 92 HIV-uninfected US adolescent young women aged between 12 and 20 years, Moscicki et al. found that HIV infection was not associated with ectopy in multivariate analyses (AOR: 0.60, 95% CI: 0.33–1.11), although a significant negative association was noted in univariate analysis (OR: 0.55, 95% CI: 0.31–0.98). The lack of an association in multivariate RXDX-106 analyses was attributed to confounding by sexual behavior. A cross-sectional study conducted among 481 Thai female partners of HIV-infected men found that cervical ectopy was not associated with HIV
infection (OR: 1.3, 95% CI: 0.9–2.0); a similar finding was also noted in a case–control study conducted among 4404 Kenyan women attending family planning clinics (OR: 1.3, 95% CI: 0.7–2.1).[31, 32] In a recent secondary analysis of a randomized controlled trial conducted to assess the impact of HSV-2 suppressive therapy to decrease HIV acquisition conducted among women in Tanzania, there was no significant association between acquiring HIV and cervical ectopy (any ectopy: age-adjusted hazard ratio, HR: 1.54, 95% CI: 0.61–3.89; >20% ectopy: age-adjusted HR: 3.26, 95% CI: 0.44–23.85). Although the negative evidence cited above demonstrates that the cervix is not necessary for transmission, it does not disprove the hypothesis that the cervix is a site of increased susceptibility to HIV in women. A limitation with most observational studies to date reporting on an association between HIV and ectopy is that they have been those conducted among
women who also have a high coprevalence of other STIs, which can also result in the disruption of the mucosal barrier independent of cervical ectopy. Most studies assessing cervical ectopy have relied on gross visual inspection via speculum of the female genital tract, which can introduce measurement bias. Friability and inflammation could result in overestimating the true frequency of ectopy. The problem of assessing cervical ectopy in high-risk populations is that they are more likely to have cervical inflammation and friability that can be mistaken for ectopy on gross visual examination. Some studies have used other methods to assess ectopy, such as cervical photographs read without knowledge of patient status.