title: Atypical squamous cells, cannot exclude high grade squamous intraepithelial (ASC-H) in HIV-positive women.
abstract: OBJECTIVE
  South Africa has very high rates of both HIV infection and cervical pathology. The management of ASC-H is colposcopy and directed biopsy, but with so many women diagnosed with HSIL and a dearth of colposcopy centres in South Africa, women with cytologic diagnosis of ASC-H may not be prioritized for colposcopy. The aim of this study was to determine if HIV-positive women with a cytologic diagnosis of ASC-H should undergo immediate colposcopy or whether colposcopy can be delayed, within the context of an underfunded health care setting with so many competing health needs.
  
  
  METHODS
  A computer database search was performed from the archives of an NGO-administered clinic that offers comprehensive HIV care. All women with a cytologic diagnosis of ASC-H on cervical smears from September 2005 until August 2009 were identified. Histologic follow up was sought in all patients.
  
  
  RESULTS
  A total of 2111 cervical smears were performed and 41 diagnosed as ASC-H (1.94%). No histologic follow up data was available in 15 cases. Follow up histologic results were as follows: three negative (11.5%), five koilocytosis and/ or CIN1 (19.2%), ten CIN2 (38.5%) and eight CIN3 (30.8%). There were no cases of invasive carcinoma on follow up.
  
  
  CONCLUSIONS
  The current appropriate management of HIV-positive women in low-resource settings with a diagnosis of ASC-H on cervical smear is colposcopy, despite the costs involved. In the future and if cost-effective in developing nations, use of novel markers may help select which HIV-positive women can be managed conservatively and which ones referred for more active treatment. More research in this regard is warranted.
authors.affiliation: Department of Anatomical Pathology, Cytopathology Unit, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Pam
authors.initials: P
authors.lastname: Michelow
authors.forename: Ingrid
authors.initials: I
authors.lastname: Hartman
authors.forename: Doreen
authors.initials: D
authors.lastname: Schulze
authors.forename: Stella
authors.initials: S
authors.lastname: Lamla-Hillie
authors.forename: Sophie
authors.initials: S
authors.lastname: Williams
authors.forename: Simon
authors.initials: S
authors.lastname: Levin
authors.forename: Cynthia
authors.initials: C
authors.lastname: Firnhaber