Cervical Cytologie Abnormalities in HIV-Seropositive Women: Cytologie and Histologie Correlation

Abstract

A high prevalence of squamous intraepithelial lesions (SIL) and human papillomavirus (HPV) occurs among women with HIV infection. A retrospective chart and Pap smear review was done on 136 HIV-seropositive women to assess the prevalence of cervical neoplasia, to correlate Pap smear results with demographic and clinical variables, and to analyze whether Pap smear abnormalities correlate with colposcopic and histologie findings. Cytologie abnormality was considered present when Pap smear reading was SIL or two atypical smears. Fortytwo percent of the women had cytologie abnormalities, and 61% of women with CD4 counts <200/mm³ and 35% of women with CD4 counts >200/mm³ had cytologie abnormalities (p < 0.05). No association was found between age, race, or HIV risk group and the presence of SIL. Forty-six percent of women with abnormal Pap smears had colposcopy. Child care, transportation, and fear of the procedure were impediments for women undergoing colposcopy. Of those who had colposcopy, 23% had high-grade SIL, and 58% had low-grade SIL. Of the women who had colposcopy, 81% also had HPV on histologie study. Sixty-five percent (17/26) of abnormal Pap smears were entirely consistent with histologie findings on colposcopy. Ninety-two percent (24/26) of the women had histologie findings no more severe than suggested by Pap smear. Our data show a high prevalence of SIL and HPV in HIV-positive women and demonstrate that SIL is more prevalent in women with CD4 counts <200/mm³. Pap smears rarely underestimated the degree of abnormality as determined by colposcopic biopsy.