Outcome after negative colposcopy among human immunodeficiency virus-infected women with borderline cytologic abnormalities.
OBJECTIVE
To estimate the risk of and risk factors for progression among human immunodeficiency virus (HIV)-seropositive women with abnormal cervical cytology but negative colposcopy.


METHODS
In a prospective cohort study, 391 HIV-seropositive and 103 seronegative women with cervical cytology read as atypical squamous cells (ASC) or low-grade squamous intraepithelial lesion (LSIL) but negative colposcopy were followed up for a mean of 4.0 years with cytology at 6-month intervals. Colposcopy was prescribed for any epithelial abnormality.


RESULTS
Progression to CIN2, CIN3, high-grade SIL/severe dysplasia, or cancer occurred in 47 (12%) HIV-seropositive women and 4 (4%) HIV-seronegative women (P = .02). Progression to CIN1 was seen in an additional 12 HIV-seropositive women and 1 seronegative woman. In multivariate analysis, high-risk but not low-risk HPV detection (hazard ratio [HR] 2.46-95% confidence interval [CI] 1.18-5.12, P = .02 for high risk, HR 1.41, 95% CI 0.62-3.21, P = .42 for low risk), satisfactory colposcopy (HR 2.01, 95% CI 1.11-3.65, P = .02), and non-Hispanic African-American ethnicity (HR 5.08, 95% CI 1.72-14.98, P = .003) were the only factors associated with progression, while HIV serostatus was marginally significant (HR 2.53, 95% CI 0.85-7.50, P = .09).


CONCLUSIONS
Human immunodeficiency virus-seropositive women with negative colposcopy after borderline cytology face a higher risk of progression than seronegative women, but the absolute risk is low and becomes nonsignificant after controlling for HPV risk type, ethnicity, and colposcopic findings. Observation is appropriate.


METHODS
II-2.
Massad
L Stewart
LS
Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9640, USA. LSMASSAD@ameritech.net
Evans
Charlesnika T
CT
Strickler
Howard D
HD
Burk
Robert D
RD
Watts
D Heather
DH
Cashin
Lorraine
L
Darragh
Teresa
T
Gange
Stephen
S
Lee
Yi-Chun
YC
Moxley
Michael
M
Levine
Alexandra
A
Passaro
Douglas J
DJ
D000328:Adult; D003127:Colposcopy; D018450:Disease Progression; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology*; D006801:Humans; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology