title: Incidence of cervical precancers among HIV-seropositive women.
abstract: OBJECTIVE
  The objective of the study was to estimate the impact of human immunodeficiency virus (HIV) infection on the incidence of high-grade cervical intraepithelial neoplasia (CIN).
  
  
  METHODS
  HIV-seropositive and comparison seronegative women enrolled in a prospective US cohort study were followed up with semiannual Papanicolaou testing, with colposcopy for any abnormality. Histology results were retrieved to identify CIN3+ (CIN3, adenocarcinoma in situ, and cancer) and CIN2+ (CIN2 and CIN3+). Annual detection rates were calculated and risks compared using a Cox analysis. Median follow-up (interquartile range) was 11.0 (5.4-17.2) years for HIV-seronegative and 9.9 (2.5-16.0) for HIV-seropositive women.
  
  
  RESULTS
  CIN3+ was diagnosed in 139 HIV-seropositive (5%) and 19 HIV-seronegative women (2%) (P<.0001), with CIN2+ in 316 (12%) and 34 (4%) (P<.0001). The annual CIN3+ detection rate was 0.6 per 100 person-years in HIV-seropositive women and 0.2 per 100 person-years in seronegative women (P<.0001). The CIN3+ detection rate fell after the first 2 years of study, from 0.9 per 100 person-years among HIV-seropositive women to 0.4 per 100 person-years during subsequent follow-up (P<.0001). CIN2+ incidence among these women fell similarly with time, from 2.5 per 100 person-years during the first 2 years after enrollment to 0.9 per 100 person-years subsequently (P<.0001). In Cox analyses controlling for age, the hazard ratio for HIV-seropositive women with CD4 counts less than 200/cmm compared with HIV-seronegative women was 8.1 (95% confidence interval, 4.8-13.8) for CIN3+ and 9.3 (95% confidence interval, 6.3-13.7) for CIN2+ (P<.0001).
  
  
  CONCLUSIONS
  Although HIV-seropositive women have more CIN3+ than HIV-seronegative women, CIN3+ is uncommon and becomes even less frequent after the initiation of regular cervical screening.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO. Electronic address: massadl@wudosis.wustl.edu.
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Xianhong
authors.initials: X
authors.lastname: Xie
authors.affiliation: Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Gypsyamber
authors.initials: G
authors.lastname: D'Souza
authors.affiliation: Departments of Pathology and Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Darragh
authors.affiliation: Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY.
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
authors.affiliation: Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY; Department of Obstetrics and Gynecology, Montefiore Medical Center, Bronx, NY.
authors.forename: Rodney
authors.initials: R
authors.lastname: Wright
authors.affiliation: Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC.
authors.forename: Christine
authors.initials: C
authors.lastname: Colie
authors.affiliation: Department of Medicine, University of Southern California School of Medicine, Los Angeles, CA.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Sanchez-Keeland
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Howard D
authors.initials: HD
authors.lastname: Strickler
mesh_terms: D065311:Adenocarcinoma in Situ / Q000453:epidemiology*; D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D065006:Papanicolaou Test; D011230:Precancerous Conditions / Q000453:epidemiology*; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology*
keywords: cervical cancer prevention; cervical intraepithelial neoplasia; human immunodeficiency virus in women