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. 2012 Mar;119(3):582-9.
doi: 10.1097/AOG.0b013e318244ee3d.

Effect of human immunodeficiency virus infection on the prevalence and incidence of vaginal intraepithelial neoplasia

L Stewart Massad  1 , Xianhong Xie, Ruth M Greenblatt, Howard Minkoff, Lorraine Sanchez-Keeland, D Heather Watts, Rodney L Wright, Gypsyamber D'Souza, Daniel Merenstein, Howard Strickler
Affiliations

Effect of human immunodeficiency virus infection on the prevalence and incidence of vaginal intraepithelial neoplasia

L Stewart Massad et al. Obstet Gynecol. 2012 Mar.

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.

Conclusion: 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.

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Conflict of interest statement

The other authors did not report any potential conflicts of interest.

Figures

Fig. 1
Fig. 1
Prevalence of Pap abnormality across time among women with and without human immunodeficiency virus (HIV) infection after hysterectomy.
See this image and copyright information in PMC

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