SIGNIFICANCE OF MILD CYTOLOGIC ATYPIA IN WOMEN INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS

Objective: To determine the prevalence of cervical intraepithelial neo plasia (CIN) in women who are infected with human immunodeficiency vir us (HIV) and who have mild cytologic atypia. Methods: As part of an on going, prospective study of cervical disease in HIV-infected women, Pa panicolaou smears were analyzed cross-sectionally for the diagnosis of mild cytologic atypia. Results: Mild cytologic atypia was diagnosed i n 112 (25%) of the 453 HIV-infected women enrolled in this study, comp ared with 36 (9%) of the 401 HIV-uninfected women (odds ratio [OR] 3.3 , 95% confidence interval [CI] 2.2-5.1; P < .001). Mild cytologic atyp ia was diagnosed more frequently in HIV-infected women with lower CD4 T-lymphocyte counts (chi(2) for trend, P = .015) and in those with a history of an abnormal Papanicolaou smear or treatment for cervical di sease (OR 3.0, 95% CI 1.2-7.6; P = .008). Coexistent CIN was detected by colposcopically directed biopsy in 42 (38%) of the 112 HIV-infected women with mild cytologic atypia, compared with five (14%) of the 36 HIV-uninfected women (OR 3.7, 95% CI 1.3-11.9; P = .008). Severe infla mmation with associated epithelial reparative atypia was diagnosed in 90 (20%) of the HIV-infected women and in 87 (22%) of the HIV-uninfect ed women. Coexistent CIN was detected in 12% of the HIV-infected women with severe inflammation and associated epithelial reparative atypia, compared with 2% of the HIV-uninfected women with this cytologic diag nosis (OR 5.9, 95% CI 1.2-23; P = .01). Conclusion: Mild cytologic aty pia, a frequent diagnosis on Papanicolaou smears from HIV-infected wom en, is associated with GIN. We recommend that all HIV-infected women w ith mild cytologic atypia be referred for colposcopy.