title: Accuracy of colposcopy in HIV seropositive and seronegative women with abnormal Pap tests.
abstract: OBJECTIVE
  The aim of this study is to compare colposcopic findings and the accuracy of colposcopic impression in HIV seropositive and seronegative women with abnormal Pap tests.
  
  
  METHODS
  HIV seropositive and seronegative women in a national cohort study had Pap tests collected every six months, with colposcopy for any abnormal result. Prospectively collected colposcopy and histology findings were analyzed retrospectively using Pearson Chi-square, t-test and Wilcoxon two-sample tests, logistic regression models, and Kappa coefficients.
  
  
  RESULTS
  After adjusting for age and Pap result, 1618 eligible HIV seropositive women were more likely than 406 seronegative women to have inadequate colposcopic examinations, abnormal colposcopic findings, and large cervical lesions. However, among those with abnormal colposcopy, colposcopic characteristics and lesion size and number did not differ by HIV serostatus. Agreement between colposcopists' impressions and highest grade biopsy diagnoses was fair (kappa coefficient 0.35, 95% C.I. 0.31, 0.38). Agreement did not differ by HIV serostatus and did not improve with multiple biopsies (weighted kappa coefficient 0.35, 95% C.I. 0.32, 0.39) or after including all histology results over two years following colposcopy.
  
  
  CONCLUSIONS
  Although HIV seropositive women with abnormal cytology are more likely to have colposcopic abnormality, the performance of colposcopy appears to be similar to that in HIV seronegative women. Biopsy is required to confirm colposcopic impression.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA. Electronic address: massadl@wudosis.wustl.edu.
authors.forename: L
authors.initials: L
authors.lastname: Stewart Massad
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Gypsyamber
authors.initials: G
authors.lastname: D'Souza
authors.affiliation: Department of Pathology and Obstetrics, University of California, San Francisco, CA, USA; Department of Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Darragh
authors.affiliation: Maimonides Medical Center, Brooklyn, NY, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
authors.affiliation: Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Rodney
authors.initials: R
authors.lastname: Wright
authors.affiliation: Division of Infectious Diseases and Travel Medicine, Department of Medicine, Georgetown University, Washington, DC, USA.
authors.forename: Seble
authors.initials: S
authors.lastname: Kassaye
authors.affiliation: University of Southern California, Los Angeles, CA, USA.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Sanchez-Keeland
authors.affiliation: Department of Preventive Medicine and Center for Healthcare Studies, Northwestern University, Chicago, IL, USA; Department of Veterans Affairs Center of Innovation for Complex Chronic Healthcare, Edward Hines J. VA Hospital, Hines, IL, USA.
authors.forename: Charlesnika T
authors.initials: CT
authors.lastname: Evans
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003127:Colposcopy / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006679:HIV Seropositivity / Q000175:diagnosis*; D006801:Humans; D065006:Papanicolaou Test / Q000379:methods; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000821:virology*; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000821:virology*
keywords: Cervical intraepithelial neoplasia; Colposcopy; HIV in women; Pap test