title: HPV testing for triage of HIV-infected women with papanicolaou smears read as atypical squamous cells of uncertain significance.
abstract: OBJECTIVE
  To assess the utility of testing for high-risk human papillomavirus (HPV) DNA as a triage strategy for detecting cervical intraepithelial neoplasia (CIN) grade 2/3 in women with human immunodeficiency virus-1 (HIV-1) infection and cytology read as atypical cells of uncertain significance (ASCUS).
  
  
  METHODS
  Conventional cervical cytology and cervicovaginal lavage were obtained at 6-month intervals between October 1, 1994, and September 30, 2002, from women enrolled in the Women's Interagency HIV Study, a multicenter cohort studying the natural history of HIV in women. HPV typing was performed by PCR. HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68 were classified as carrying high oncogenic risk. Women with ASCUS smears were referred for colposcopy. Analyses of the sensitivity of HPV testing were cross-sectional, using colposcopy results within 90 days of first ASCUS result.
  
  
  RESULTS
  Of the 270 women evaluated, 7 (3%) had CIN 2, and 3 (1%) had CIN3 or adenocarcinoma in situ. High-risk HPV DNA was found in 81 (30%) of the 270 participants. The sensitivity of high-risk HPV DNA detection for CIN 2/3 was 50% (95% CI 0.19, 0.81), the specificity was 71% (95% CI 0.65, 0.76), the positive predictive value was 6% (95% CI 0.01, 0.11), and the negative predictive value was 97% (95% CI 0.95, 1.00). HPV of any risk type was found in 176 (65%) of the 270 women, including 9 of 10 women with CIN 2/3, for a sensitivity of 90% (95% CI 0.56, 1.00), a specificity of 36% (95% CI 0.30, 0.42), a positive predictive value of 5% (95% CI 0.02, 0.08), and a negative predictive value of 99% (95% CI 0.94, 1.00).
  
  
  CONCLUSIONS
  For women with HIV and Papanicolaou smears read as ASCUS, DNA testing for high risk HPV may not be sensitive enough for clinical use.
authors.affiliation: Department of Obstetrics and Gynecology, Southern Illinois School of Medicine, Springfield, Illinois 62794, USA. smassad@siumed.edu
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
authors.forename: Michael F
authors.initials: MF
authors.lastname: Schneider
authors.forename: D Heather
authors.initials: DH
authors.lastname: Watts
authors.forename: Howard D
authors.initials: HD
authors.lastname: Strickler
authors.forename: Sandra
authors.initials: S
authors.lastname: Melnick
authors.forename: Joel
authors.initials: J
authors.lastname: Palefsky
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anastos
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Levine
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000821:virology; D015331:Cohort Studies; D003127:Colposcopy; D015344:DNA Probes, HPV; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D015658:HIV Infections / Q000473:pathology*; D015497:HIV-1; D006801:Humans; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000473:pathology* / Q000821:virology; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014218:Triage; D014481:United States; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000821:virology; D014626:Vaginal Smears
chemical_list: D015344:DNA Probes, HPV; D004279:DNA, Viral