Colposcopy is not necessary to assess the risk to the cervix in HIV-positive women: an international cohort study of cervical pathology in HIV-1 positive women.
The objectives of this prospective multicentre international cohort study are to describe the characteristics of a cohort of HIV-1 positive women and determine the best management system by comparing cervical pathology according to results of cytology, colposcopy and human papillomavirus (HPV) testing at baseline and throughout follow-up. A. Cohorts of known HIV-positive women were recruited from 6 hospital-based European centres and a community-based South African centre. Following registration, women were reviewed every 6 months to undergo cervical surveillance including cytology, colposcopy, histopathology and HPV testing, using the HPV hybrid capture assay. Independent risk factors for the incidence of cytological abnormality and acquisition/clearance of HPV infection during follow up were identified. A total of 1,534 women were recruited, 400 of which were from South Africa. At baseline, among European women, 66% had normal cytology and half were HPV negative and among South African women, 45% had normal cytology and one third (32%) were HPV negative. The sensitivity of cytology (>/=ASCUS) matched with that of colposcopy to detect CIN2+. Rate of detection of high grade CIN at 2 years was similar in European and South African women (11 and 9.3%, respectively). Cytology and HPV testing alone were each sufficiently sensitive as a screening test at 2 yearly intervals. Our data confirm the high prevalence of low-grade cytological abnormalities and high-risk HPV infection. Cytology appears to be sufficient for cervical surveillance, with HPV testing being less specific with poor positive predictive value. There appears to be no additional benefit from routine colposcopy.
Academic Unit of Obstetrics and Gynaecology, University of Manchester, St. Mary's Hospital, Manchester, United Kingdom. henry.kitchener@cmmc.nhs.uk
Henry
H
Kitchener
Linsey
L
Nelson
Joanna
J
Adams
David
D
Mesher
Peter
P
Sasieni
Heather
H
Cubie
Catherine
C
Moore
Isabelle
I
Heard
Alberto
A
Agarossi
Elena
E
Casolati
Lynette
L
Denny
Caroline
C
Bradbeer
Fiona
F
Lyons
Gerry
G
Beattie
Tomasz
T
Niemiec
D000328:Adult; D000704:Analysis of Variance; D002584:Cervix Uteri / Q000473:pathology* / Q000821:virology*; D015331:Cohort Studies; D003127:Colposcopy; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000473:pathology*; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D016017:Odds Ratio; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D011159:Population Surveillance; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D019564:Unnecessary Procedures; D019562:Viral Load