Using the number of koilocytes to predict HIV serostatus in women with HPV-associated SIL.
OBJECTIVE
To investigate the relationship between specific cytopathologic changes, koilocyte counts and human papillomavirus (HPV) types in HIV-positive and -negative women.


METHODS
A cohort of 459 women (266 HIV+ and 193 HIV-), were examined in a multicentric study (Early Diagnosis of Neoplasia in AIDS) involving 14 gynecologic centers. Altogether, 97 women had cervical smears consistent with squamous intraepithelial lesions (SIL). Koilocytes were found in 60/97 SIL slides, subjected to quantitative counting in 30 predetermined fields. HPV genotype was determined by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis.


RESULTS
SIL lesions were four times more frequent (29%) in HIV-positive women than in HIV-negative women (10%) (odds ratio = 3.80). HPV DNA was equally frequent in both groups. There was a strong association between the number of koilocytes and HIV serostatus in both high grade and low grade SIL diagnoses. The presence of eight or more koilocytes had a specificity of 93% and sensitivity of 76% toward the diagnosis of HIV-positive status. No HIV-negative woman had a count > 8 koilocytes. No association was shown between koilocyte count and HPV genotype.


CONCLUSIONS
An elevated number of koilocytes could suggest the possibility of HIV infection. Pap smear examination might give the first clue to HIV positivity in otherwise-unsuspected cases.
Branca
M
M
Laboratory of Epidemiology and Biostatistics, Cytopathology Unit, National Institute of Health, Rome, Italy.
Migliore
G
G
Giuliani
M
M
Morosini
P L
PL
Mudu
P
P
Cappiello
G
G
Garbuglia
A R
AR
Ippolito
G
G
Rezza
G
G
D000328:Adult; D002278:Carcinoma in Situ / Q000150:complications / Q000473:pathology* / Q000821:virology*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology* / Q000821:virology*; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D006679:HIV Seropositivity / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000235:genetics*; D030361:Papillomavirus Infections / Q000150:complications / Q000473:pathology*; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D014412:Tumor Virus Infections / Q000150:complications / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000473:pathology* / Q000821:virology*; D014626:Vaginal Smears
D004279:DNA, Viral