title: Prevalence, risk factors, and accuracy of cytologic screening for cervical intraepithelial neoplasia in women with the human immunodeficiency virus.
abstract: OBJECTIVE
  The objective was to evaluate the sensitivity and specificity of cervical cytology in women infected with the human immunodeficiency virus (HIV), risk factors for abnormal cytology in HIV-infected and uninfected women, and risk factors for histologic diagnosis of cervical intraepithelial neoplasia (CIN) in HIV-infected women.
  
  
  METHODS
  Methods included a cross-sectional analysis of cervical cytology, colposcopic impression, and histology in 248 HIV-infected women and multivariate analyses of risk factors for abnormal cytology in 253 HIV-infected and 220 uninfected women and risk factors for CIN in 186 HIV-infected women.
  
  
  RESULTS
  The sensitivity and specificity of cytology for all CIN grades were 0.60 and 0.80 and, for high-grade CIN, 0.83 and 0.74. The prevalence of abnormal cytology was 32.9% in HIV-infected and 7.6% in HIV-negative women. Independent risk factors for abnormal cytology were immunodeficiency [odds ratio (OR) 8-17, P < 0.001] and human papillomavirus (HPV) infection (OR = 5, P < 0.001). The prevalence of CIN on histology was 32% in HIV-infected women, and the only independent risk factor for CIN was oncogenic HPV type (OR = 5, P = 0.005).
  
  
  CONCLUSIONS
  Given the high prevalence of abnormal cytology and CIN in HIV-infected women, cytologic screening has significant limitations. Both immunodeficiency and type of HPV infection are important risk factors.
authors.affiliation: Department of Obstetrics and Gynecology, State University of New York-Health Science Center at Brooklyn 11203, USA.
authors.forename: M
authors.initials: M
authors.lastname: Maiman
authors.forename: R G
authors.initials: RG
authors.lastname: Fruchter
authors.forename: A
authors.initials: A
authors.lastname: Sedlis
authors.forename: J
authors.initials: J
authors.lastname: Feldman
authors.forename: P
authors.initials: P
authors.lastname: Chen
authors.forename: R D
authors.initials: RD
authors.lastname: Burk
authors.forename: H
authors.initials: H
authors.lastname: Minkoff
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000166:cytology* / Q000821:virology*; D003430:Cross-Sectional Studies; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000473:pathology*; D006801:Humans; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000821:virology*; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000821:virology*