title: Effect of human immunodeficiency virus infection on the prevalence and incidence of vaginal intraepithelial neoplasia.
abstract: OBJECTIVE
  To estimate the prevalence, incidence, and clearance of abnormal vaginal cytology and vaginal intraepithelial neoplasia (VAIN) in human immunodeficiency virus (HIV)-seropositive women.
  
  
  METHODS
  Pap tests were done semiannually for 335 HIV-seropositive and 75 HIV-seronegative women with prior hysterectomy in the prospective Women's Interagency HIV Study cohort. End points included abnormal Pap test results after hysterectomy and VAIN regardless of hysterectomy.
  
  
  RESULTS
  Over a median of 5.6 years of follow-up, vaginal Pap test results were abnormal at 1,076 (29%; 95% confidence interval [CI] 25-33%) of 3,700 visits among HIV-seropositive compared with 31 (4%; 95% CI 2-8%) of 763 visits among HIV-seronegative women (P<.001). Abnormal Pap test results included 641 atypical squamous cells of undetermined significance, 425 low-grade squamous intraepithelial lesions, and 10 high-grade squamous intraepithelial lesions in HIV-seropositive women and 28 atypical squamous cells of undetermined significance and three low-grade squamous intraepithelial lesions in HIV-seronegative women. The incidence of abnormal Pap test results after hysterectomy was 14 per 100 person-years among HIV-seropositive and two per 100 person-years among HIV-seronegative women (P<.001) and remained stable across time. The 5-year clearance rate of abnormal Pap test results was 34 per 100 person-years for HIV-seropositive and 116 per 100 person-years for HIV-seronegative women (P<.001). In multivariate regression models, women with lower CD4 counts were more likely to have and less likely to clear abnormal cytology when it occurred. The incidence of VAIN 2 or worse was 0.2 and 0.01 per 100 person-years for HIV-seropositive and HIV-seronegative women (P=.001). Two HIV-seropositive women developed stage II cancers with remission after radiotherapy.
  
  
  CONCLUSIONS
  Vaginal Pap test results are often abnormal in HIV-seropositive women. Although more common than in HIV-seronegative women, VAIN 2 or worse and especially vaginal cancers are infrequent.
authors.affiliation: Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, Missouri 63110, USA. massadl@wudosis.wustl.edu
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
authors.forename: Xianhong
authors.initials: X
authors.lastname: Xie
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Greenblatt
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
authors.forename: Lorraine
authors.initials: L
authors.lastname: Sanchez-Keeland
authors.forename: D Heather
authors.initials: DH
authors.lastname: Watts
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Wright
authors.forename: Gypsyamber
authors.initials: G
authors.lastname: D'Souza
authors.forename: Daniel
authors.initials: D
authors.lastname: Merenstein
authors.forename: Howard
authors.initials: H
authors.lastname: Strickler
mesh_terms: D000328:Adult; D044383:Black People / Q000706:statistics & numerical data; D018791:CD4 Lymphocyte Count; D002278:Carcinoma in Situ / Q000453:epidemiology* / Q000208:ethnology / Q000276:immunology / Q000821:virology*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000276:immunology; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015995:Prevalence; D014625:Vaginal Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000276:immunology / Q000821:virology*; D014626:Vaginal Smears / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology