THE ADEQUACY OF CYTOLOGY AND COLPOSCOPY IN DIAGNOSING CERVICAL NEOPLASIA IN HIV-SEROPOSITIVE WOMEN

The purpose of this study was to compare cytology and colposcopy as pr edictors of cervical intraepithelial neoplasia (CIN) in women infected with the human immunodeficiency virus (HIV). A cross-sectional analys is of cytology, colposcopy, and colposcopic biopsy results from 51 HIV -seropositive women attending an ambulatory HIV service was conducted. Cytology slides were reviewed by two cytopathologists blinded to pati ents' HIV status. There was strong agreement in the readings of two cy topathologists with a kappa score of 0.9. Of 29 women with normal cyto logy, 21 (72%) had pathology on histology, including 7 (24%) with CIN. Colposcopic impression correlated well with histology results. Of 22 women with abnormal cytology, 82% had abnormal histology. The overall prevalence of CIN was high at 45%, increasing from 35% in women with C D4 counts over 400 to 56% in women with CD4 counts below 200. In concl usion, screening cytology is limited by false-negative results; routin e colposcopy should be considered in this high-risk population. (C) 19 94 Academic Press, Inc.