The role of human papillomavirus deoxyribonucleic acid assay and repeated cervical cytologic examination in the detection of cervical intraepithelial neoplasia among human immunodeficiency virus-infected women. Cervical Disease Study Group of the American Foundation for AIDS Research Community Based Clinical Trials Network.
OBJECTIVE
We sought to measure the characteristics of a quantitative human papillomavirus deoxyribonucleic acid assay and repeated cervical cytologic examination in screening for cervical intraepithelial neoplasia among human immunodeficiency virus-infected women.


METHODS
Human immunodeficiency virus-infected women with screening CD4+ lymphocyte counts of < or = 500 cells/mm3 (n = 103) were examined by quantitative human papillomavirus deoxyribonucleic acid assay and serial cervical cytologic examination and by colposcopy with biopsy and endocervical curettage during the course of 1 year.


RESULTS
Quantitative measures of total human papillomavirus deoxyribonucleic acid and high-risk human papillomavirus deoxyribonucleic acid were strongly associated with any cervical intraepithelial neoplasia (P = .005) and high-grade cervical intraepithelial neoplasia (P = .0006), but they improved the sensitivity and negative predictive value of baseline screening only slightly when combined with cervical cytologic examination. Incident cervical intraepithelial neoplasia occurred frequently (20%) during 1 year of follow-up and was more common among human papillomavirus-infected women. Repeated cytologic examination identified 60% of women with new cervical intraepithelial neoplasia.


CONCLUSIONS
Human immunodeficiency virus-infected women with at least mild immunosuppression have a high incidence of cervical intraepithelial neoplasia, which warrants close follow-up. Those with high baseline human papillomavirus deoxyribonucleic acid levels may be at the highest risk for incident cervical intraepithelial neoplasia.
University of Maryland Medical Center, the Baltimore Community Research Initiative, Baltimore, USA.
J A
JA
Cohn
S
S
Gagnon
M R
MR
Spence
D D
DD
Harrison
T R
TR
Kluzak
P
P
Langenberg
C
C
Brinson
A
A
Stein
J
J
Hellinger
D000328:Adult; D001706:Biopsy; D003127:Colposcopy; D003475:Curettage; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000821:virology; D006651:Histocytochemistry; D006801:Humans; D016013:Likelihood Functions; D008875:Middle Aged; D027383:Papillomaviridae / Q000737:chemistry / Q000235:genetics*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D012372:ROC Curve; D014412:Tumor Virus Infections / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology / Q000821:virology
D004279:DNA, Viral