Histologic correlates of glandular abnormalities in cervical cytology among women with human immunodeficiency virus.
OBJECTIVE
To estimate the frequency and histologic correlates of glandular abnormalities in cervical cytology among women with the human immunodeficiency virus (HIV) and to compare findings with those of women without HIV.


METHODS
In a cohort study of HIV-infected and uninfected women followed between 1994 and 2007, Pap tests were obtained every 6 months. Glandular abnormalities, including atypical glandular cells (AGC), adenocarcinoma in situ (AIS), and adenocarcinoma, were identified and correlated with biopsy histology. Multivariate models to summarize data across visits used generalized estimating equations. The association of Pap and histology results was assessed using chi tests.


RESULTS
Of 48,362 Pap tests from 3,766 women, glandular abnormalities were found in 341 (0.7%) tests from 244 (6%) women, including 93 (1.0%) of 9,564 Pap tests among HIV-seropositive women with CD4 lymphocyte counts less than 250/mm, 103 (0.8%) of 13,023 tests among those with counts 250-500/mm, 68 (0.6%) of 12,470 tests among women with counts greater than 500/mm, and 70 (0.6%) of 11,769 tests among HIV-seronegative women (P for trend=.006). Colposcopy was documented for only 148 (61%) of 244 index Pap tests in women with glandular abnormalities. After index abnormal tests, endocervical curettings were obtained from 106 (43%) women, cervical biopsies from 76 (38%), and endometrial biopsies from 19 (8%). Squamous lesions predominated among histologic findings and histology results did not differ by HIV serostatus (P=.16).


CONCLUSIONS
Although immunosuppression increased the risk of glandular Pap test abnormalities in women with HIV, these remained uncommon. Compliance with management guidelines can improved.


METHODS
II.
Massad
L Stewart
LS
From the Washington University School of Medicine, Springfield, Illinois; Albert Einstein College of Medicine, Bronx, New York; University of California, San Francisco, California; Maimonides Medical Center, Brooklyn, New York; City of Hope National Medical Center, Duarte, California, and Keck School of Medicine, University of Southern California, Los Angeles, California; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Montefiore Medical Center, Bronx, New York; Georgetown University, Washington, DC; Eunice Kennedy Shriver National Institute for Child Health and Human Development, Bethesda, Maryland; Albert Einstein College of Medicine, Bronx, New York.
Xie
Xianhong
X
Darragh
Teresa M
TM
Minkoff
Howard
H
Levine
Alexandra M
AM
D'Souza
Gypsyamber
G
Cajigas
Anthony
A
Colie
Christine
C
Watts
D Heather
DH
Strickler
Howard D
HD
D000230:Adenocarcinoma / Q000473:pathology / Q000821:virology; D001706:Biopsy; D018791:CD4 Lymphocyte Count; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy; D004717:Endometrium / Q000473:pathology; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000473:pathology*; D006679:HIV Seropositivity / Q000473:pathology; D006801:Humans; D030361:Papillomavirus Infections / Q000150:complications; D012907:Smoking; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000473:pathology / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology