CERVICAL INTRAEPITHELIAL NEOPLASIA IN WOMEN INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS - PREVALENCE, RISK-FACTORS, AND VALIDITY OF PAPANICOLAOU SMEARS

Objective: To define the prevalence of cervical intraepithelial neopla sia (CIN), the validity of Papanicolaou tests, and the associations be tween CIN and risk factors for cervical disease in human immunodeficie ncy virus (HIV)-infected women. Methods: In this cross-sectional study , we enrolled 398 HIV-seropositive and 357 HIV-seronegative women from two HIV-AIDS clinics, two sexually transmitted disease clinics, a met hadone clinic, and a clinic for participants in an HIV heterosexual tr ansmission study. Each woman was interviewed and underwent a cytologic and colposcopic evaluation, and was tested for human papillomavirus ( HPV) DNA. Results: Eighty (20%) of the 398 HIV-seropositive women comp ared to 15 (4%) of the 357 seronegative women had colposcopically conf irmed CIN (odds ratio 5.7; P < .001). No invasive cancers were found. The sensitivity and specificity of Papanicolaou tests in seropositive women were 81 and 87%, respectively. By multiple logistic regression a nalysis using a model that included behavioral and biologic risk facto rs for CIN, CIN was independently associated with HPV infection (odds ratio 9.8), HIV infection (odds ratio 3.5), CD4+ T-lymphocyte count le ss than 200 cells/mu L (odds ratio 2.7), and age greater than 34 years (odds ratio 2.0). Conclusions: Cervical intraepithelial neoplasia is a common finding in HIV-infected women. However, the results of this s tudy suggest that Papanicolaou tests should be effective for detecting cervical disease in this population.