Prevalence and predictors of squamous cell abnormalities in Papanicolaou smears from women infected with HIV-1. Women's Interagency HIV Study Group.
BACKGROUND
Cervical neoplasia occurs with increased frequency among women infected with HIV-1.


OBJECTIVE
To characterize prevalence of and risk factors for abnormal cervical cytology among women with HIV and to compare them to uninfected women.


METHODS
Baseline cervical cytology was obtained from 1713 women seropositive for HIV and 482 at-risk control women who were enrolled in the Women's Interagency HIV Study, a multicenter prospective cohort study conducted in six U.S. cities. Associations with sociodemographic, medical, and sexual variables were assessed by Fisher's exact test, Mantel extension test, and logistic regression analysis.


RESULTS
Cervical cytology was abnormal in 38.3% of HIV-infected women (atypical squamous cells of uncertain significance [ASCUS] 20.9%, low-grade squamous cells of uncertain significance [LSIL] 14.9%, high-grade squamous cells of uncertain significance [HSIL] 2.3%, cancer 0.2%) and 16.2% of HIV-uninfected women (ASCUS 12.7%, LSIL 2.3%, HSIL 1.2%, cancer 0.0%). Risk factors for any abnormal cytology in multivariate analysis included HIV infection, CD4 cell count, HIV RNA level, detection of human papillomavirus (HPV), a prior history of abnormal cytology, employment, and number of male sex partners within 6 months of enrollment. Prior abortion was associated with a decreased risk of cytologic abnormality.


CONCLUSIONS
Cervical cytologic abnormalities were frequent among women infected with HIV, although high-grade changes were found in only 2.5%. Factors linked to sexual and reproductive history, HPV infection, and HIV disease all influenced risk.
Massad
L S
LS
Department of Obstetrics and Gynecology, Cook County Hospital and Rush Medical College, Chicago, Illinois, USA. lsmassad@ameritech.net
Riester
K A
KA
Anastos
K M
KM
Fruchter
R G
RG
Palefsky
J M
JM
Burk
R D
RD
Burns
D
D
Greenblatt
R M
RM
Muderspach
L I
LI
Miotti
P
P
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D016022:Case-Control Studies; D015331:Cohort Studies; D015344:DNA Probes, HPV; D005260:Female; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000150:complications / Q000473:pathology*; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification; D015995:Prevalence; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology
D015344:DNA Probes, HPV; D012367:RNA, Viral