Abnormal vaginal cytology in HIV-infected and at-risk women after hysterectomy.
OBJECTIVE
To determine the frequency of and risk factors for abnormal vaginal Papanicolaou smears in HIV-infected women after hysterectomy.


METHODS
Data were from the HIV Epidemiology Research (HER) study, a prospective multisite study of HIV-infected and uninfected women. Semiannual vaginal Papanicolaou smears and colposcopy data were obtained from 102 HIV-infected and 46 at-risk women who had hysterectomy either before or during the study. Analytic models used include Cox proportional hazards (women with hysterectomy during the study) and multiple logistic regressions, which corrected for repeated measures (all women).


RESULTS
Among the HIV-infected women, evidence of cervical intraepithelial neoplasia before or at hysterectomy was associated with abnormal cytology during follow-up; 63% had squamous intraepithelial lesions (SIL) on vaginal Papanicolaou smears following hysterectomy. CD4 counts of <200 cells/microL at hysterectomy and HIV viral load of >10,000 copies/mL at hysterectomy were predictive of SIL vaginal cytology. Prevalent SIL vaginal cytology was associated with low CD4 count and human papillomavirus risk type. Of the 102 HIV-infected women, 16 (16%) had vaginal intraepithelial neoplasia on biopsy.


CONCLUSIONS
The high rate of SIL on vaginal Papanicolaou smears and the presence of high-grade vaginal intraepithelial neoplasia among HIV-infected women after hysterectomy demonstrate the need for continued follow-up for lower genital tract lesions.
Paramsothy
Pangaja
P
Contraceptive Research and Development (CONRAD) Program, Arlington, VA, USA.
Duerr
Ann
A
Heilig
Charles M
CM
Cu-Uvin
Susan
S
Anderson
Jean R
JR
Schuman
Paula
P
Klein
Robert S
RS
D000328:Adult; D003127:Colposcopy; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy; D018307:Neoplasms, Squamous Cell / Q000473:pathology; D065006:Papanicolaou Test; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States; D014621:Vagina / Q000473:pathology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology