Abnormal Vaginal Pap Test Results After Hysterectomy in Human Immunodeficiency Virus-Infected Women.
To evaluate the prevalence of abnormal vaginal cytology and vaginal intraepithelial neoplasia (VAIN) and vaginal cancer in human immunodeficiency virus (HIV)-infected women with no history of abnormal cytologic screening who had a hysterectomy for conditions other than cervical dysplasia and cancer and to explore the risk factors associated with VAIN and vaginal cancer.



A retrospective cohort study was performed identifying 238 women between January 2000 and January 2015 with a history of HIV, previous hysterectomy, and no previous abnormal Pap test results. Medical records from patients with both HIV and a history of hysterectomy were reviewed from Thomas Street Health Center and Northwest Community Health Center.



Among 238 women, 164 (69%) had normal Pap test results, 12 (5%) had results showing atypical cells of undermined significance and human papillomavirus-positive, 55 (23.1%) had results showing low-grade squamous intraepithelial lesion, and seven (2.9%) had results showing high-grade squamous intraepithelial lesion. No demographic risk factor was associated with abnormal Pap test results after hysterectomy. Median follow-up time for the Pap test was 16 years. Of those who underwent vaginal biopsies for abnormal Pap test results, 15 (28%) had normal results, 23 (43%) had VAIN 1, nine (16%) had VAIN 2, and seven (13%) had VAIN 3. No patients had invasive vaginal cancer.



More than 30% of HIV-infected women who had no prehysterectomy history of abnormal Pap test results had abnormal vaginal Pap test results. Among those who had vaginal biopsies, 29% had VAIN 2 or 3, suggesting that Pap testing posthysterectomy in the HIV population may be indicated.
Baylor College of Medicine, the MD Anderson Cancer Center, and the Harris Health System/Baylor College of Medicine, Houston, Texas.
Stephanie
S
Smeltzer
Xiaoying
X
Yu
Kathleen
K
Schmeler
Judy
J
Levison
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D065006:Papanicolaou Test / Q000379:methods*; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications / Q000473:pathology; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013781:Texas; D014625:Vaginal Neoplasms / Q000150:complications / Q000473:pathology; D014626:Vaginal Smears / Q000379:methods*; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology