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.
Cohn
J A
JA
University of Maryland Medical Center, the Baltimore Community Research Initiative, Baltimore, USA.
Gagnon
S
S
Spence
M R
MR
Harrison
D D
DD
Kluzak
T R
TR
Langenberg
P
P
Brinson
C
C
Stein
A
A
Hellinger
J
J
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