ABSTRACT
OBJECTIVE: To assess the underlying histology of HIV-infected women with minimally abnormal Pap tests compared to HIV-uninfected women by evaluating their colposcopic and histologic outcomes. METHODS: Retrospective analysis was performed to identify HIV-infected women who had at least one cervical Pap test from 2002 through 2008 at Boston Medical Center. We identified women who underwent colposcopy within 6 months of a minimally abnormal Pap test (atypical squamous cells of undetermined significance with positive high-risk human papillomavirus testing [ASCUS/HPV+] or low-grade squamous intraepithelial lesion (LSIL)). Our outcome was the proportion of HIV-infected women with histologic cervical intraepithelial neoplasia 2 or worse (CIN2+). We then compared these outcomes to those of a cohort of HIV-uninfected women from the same institution. RESULTS: There were 655 HIV-infected women who had Pap testing in the study time frame, and 146 (22%) had a minimally abnormal Pap test (ASCUS/HPV+ or LSIL). Of the 90 HIV-infected women who had subsequent colposcopy within 6 months, colposcopy was negative for 20 (22%), CIN1 for 41 (46%), and CIN2+ for the remaining 29 (32%). During the same time period, there were 747 HIV-uninfected women who underwent colposcopy within 6 months of a minimally abnormal Pap test. Colposcopy was negative for 336 (45%), CIN1 for 254 (34%), and CIN2+ for 157 (21%). After adjusting for differences in age and race, the HIV-infected women were more likely to have CIN2+ after a minimally abnormal Pap test (p=0.002) (adjusted odds ratio [OR] 2.17, 95% confidence interval [CI] 1.33-3.62). There were no diagnosed cases of cervical cancer. CONCLUSIONS: HIV-infected women have higher rates of underlying CIN2+ for minimally abnormal Pap tests compared with HIV-uninfected women.
Subject(s)
Colposcopy/statistics & numerical data , HIV Infections/epidemiology , Papillomaviridae/isolation & purification , Papillomavirus Infections/epidemiology , Uterine Cervical Dysplasia/epidemiology , Uterine Cervical Neoplasms/epidemiology , Vaginal Smears/statistics & numerical data , Adult , Boston , Comorbidity , Confidence Intervals , Female , HIV Infections/diagnosis , Humans , Middle Aged , Odds Ratio , Papillomavirus Infections/diagnosis , Predictive Value of Tests , Retrospective Studies , Risk Factors , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Dysplasia/diagnosisABSTRACT
OBJECTIVE: To assess follow-up and histologic outcomes by age for an indigent urban cohort of women with minimally abnormal cytology. STUDY DESIGN: Retrospective analysis of Pap tests was performed (January 2, 2002, to June 30, 2005). Adolescents (age < 21) and women with atypical squamous cells of undetermined significance (ASCUS)/high-risk human papillomavirus (HPV) and low-grade squamous intraepithelial lesions (LSIL) Pap results were studied and followed for outcomes at 2 years. The chi2 test was performed to evaluate differences among groups; statistical significance was established as p < or = 0.05. RESULTS: A total of 2,266 women were studied--676 adolescents, 1,063 women aged 21-30 years, and 527 women > 30 years of age. Results included 619 ASCUS/ high-risk HPV and 1,647 LSIL results. Compliance was similar across age-groups; 31% never returned for follow-up. CIN2 was detected in 18.8% of adolescents, 21.6% of women aged 21-30, and 15.7% of women > 30 years (p = 0.53). CIN3 was detected in 8.5% of adolescents, 8.1% of women aged 21-30, and 7.7% of women > 30 years (p = 0.55). CONCLUSION: Adolescents and women had similar rates of loss to follow-up after having a minimally abnormal Pap test. The likelihood of detecting CIN2-3 was similar regardless of age.
