[Accuracy of oncotic cytology for HPV infection diagnosis on the cervix uteri of HIV-infected women].
OBJECTIVE
to verify the accuracy of uterine cervix cytology for HPV diagnosis, as compared to polymerase chain reaction (PCR) in samples of women with HIV.


METHODS
158 patients who had undergone a first collection of material from the uterine cervix with Ayre's spatula for PCR were included in the study. Then, another collection with Ayre's spatula and brush for oncotic cytology was performed. Only 109 slides were reviewed, as 49 of them had already been destructed for have being filed for over two years.


RESULTS
the prevalence of HPV was 11% in the cytological exam and 69.7% in the PCR. Age varied from 20 to 61 years old, median 35 years. The HIV contagious route was heterosexual in 91.8% of the cases, and 79.1% of the patients had had from one to five sexual partners along their lives. The most frequent complaint was pelvic mass (5.1%), and 75.3% of the women had looked for the service for a routine medical appointment. The categorical variable comparison was done through contingency tables, using the chi2 test with Yates's correction to compare the ratios. The Fisher's test was used when one of the expected rates was lower than five. In the comparison of diagnostic tests, sensitivity, specificity and similarity ratios have been calculated. Among the 76 patients with HPV, detected by PCR, only 12 had the diagnosis confirmed by cytology (sensitivity=15.8%), which on the other hand did not present any false-positive results (specificity=100%). Concerning the HPV presence, the cytological prediction for positive results was 100% and 33.3% for negative, when both results were compared. Among the 12 patients with HPV positive cytology, four (33.3%) presented cervical intraepithelial neoplasia (OR=56; positive similarity ratio=positive infinity; negative similarity ratio=0.83).


CONCLUSIONS
As the cytology specificity is quite high, it is possible to rely on the positive result, which means that a positive result will surely indicate the presence of HPV. The low sensitivity of cytology does not qualify it as a survey exam for HPV detection in this female group.
de Faria
Iwens Moreira
IM
Programa Saúde da Mulher, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil. emeira@uai.com.br
Melo
Victor Hugo
VH
de Castro
Lúcia Porto Fonseca
LP
de Faria
Fernando Meira
FM
Carvalho
Nara de Oliveira
Nde O
de Araújo
Angela Cristina Labanca
AC
de Oliveira
Homero Caporali
HC
D000328:Adult; D002584:Cervix Uteri / Q000473:pathology* / Q000821:virology*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications* / Q000473:pathology*; D016133:Polymerase Chain Reaction; D015203:Reproducibility of Results; D055815:Young Adult