The significance of ASCUS cytology in HIV-positive women.
OBJECTIVE
The aim of this study was to determine the incidence and severity of dysplasia associated with a cytologic diagnosis of atypical cells of undetermined significance (ASCUS) in women infected with the human immunodeficiency virus (HIV).


METHODS
A cross-sectional analysis of cervical cytology, colposcopic impression, and cervical biopsy results was performed on 261 HIV-positive women diagnosed with ASCUS. The prevalence and grade of histologically documented cervical intraepithelial neoplasia (CIN) was determined. Patients with CD4 counts above and below 200 cells/mm(3) were compared using chi(2) analysis to determine any effect of worsening immunosuppression on the rates of associated dysplasia.


RESULTS
Seven hundred sixty-one Pap smears were performed during the study period. Two hundred nine (27%) were diagnosed as ASCUS. All patients (pts) received colposcopic evaluation. The incidence of human papilloma virus (HPV) effect, low-grade CIN (I), and high-grade CIN (II, III, and carcinoma in situ) documented by cervical biopsy, cervical conization or endocervical curettings was 40, 17, and 15%, respectively. No cases of invasive cancer were found. These results are similar to those of previous cytohistologic studies of ASCUS in HIV-untested populations. There was no significant difference in frequency or severity of CIN in pts with severe immunosuppression (P = 0.4).


CONCLUSIONS
A cytologic diagnosis of ASCUS in HIV-positive women identifies a group at significant risk for histologic abnormalities. The majority of pts will be diagnosed with HPV or low-grade CIN. HIV infection and severe immunosuppression do not appear to increase the frequency or severity of CIN associated with ASCUS. Given the 32% risk of associated CIN, all HIV-positive women with ASCUS cytology should undergo colposcopic evaluation.
Holcomb
K
K
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brooklyn, New York, 11203, USA.
Abulafia
O
O
Matthews
R P
RP
Chapman
J E
JE
Borges
A
A
Lee
Y C
YC
Buhl
A
A
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D015994:Incidence; D012720:Severity of Illness Index; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000453:epidemiology* / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000453:epidemiology / Q000473:pathology