Women with human immunodeficiency virus infection and abnormal Papanicolaou smears: a prospective study of colposcopy and clinical outcome

Abstract

Objective: To determine the effect of human immunodeficiency virus (HIV) infection on colposcopic and histologic findings and clinical outcome in women who have abnormal Papanicolaou smears.

Methods: We conducted a prospective study of women with abnormal Papanicolaou smears from among those participating in a longitudinal study of HIV infection, human papillomavirus infection, and genital neoplasia. Women with squamous intraepithelial lesions (SIL) on blindly interpreted Papanicolaou smears were referred for colposcopy and standard gynecologic care. Colposcopic and histologic findings were correlated with cytology, and differences between HIV seropositives and seronegatives were analyzed.

Results: Thirty-eight of 48 women referred underwent colposcopy, of whom 36 (94.7%) had colposcopic or histologic findings no more severe than those suggested by Papanicolaou smear. Seventeen of 25 HIV seropositives (68%) had cervical or vaginal condyloma or neoplasia, compared with three of 13 seronegatives (23%) (odds ratio [OR] 7.1, 95% confidence interval [CI] 1.5-33.0). Among seropositives, seven (28%) had cervical intraepithelial neoplasia (CIN) grade II or III; ten (40%) had cervical or vaginal condyloma, CIN I, or both; and eight (32%) had no vaginal or cervical SIL. There was no case of invasive carcinoma. Seven seropositives (28%) had or developed multicentric disease, compared with no seronegatives (P = .07). Follow-up ranged at 3-37 months and showed that all three treated seronegative women and five of ten treated seropositive women had normal examinations. Three seropositive patients had persistent disease without progression, and two had progression of condyloma. No CIN II, CIN III, or invasive carcinoma was seen during follow-up.

Conclusions: Among women seropositive for HIV who had SIL on a Papanicolaou smear, colposcopic and histologic findings were predicted reliably by the cytologic smear. Rapid progression of CIN after standard gynecologic care for early genital lesions was not seen.