PREVALENCE, RISK-FACTORS, AND ACCURACY OF CYTOLOGIC SCREENING FOR CERVICAL INTRAEPITHELIAL NEOPLASIA IN WOMEN WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS

Objectives. The objective was to evaluate the sensitivity and specific ity of cervical cytology in women infected with the human immunodefici ency virus (HIV), risk factors for abnormal cytology in HIV-infected a nd uninfected women, and risk factors for histologic diagnosis of cerv ical intraepithelial neoplasia (CIN) in HIV-infected women. Methods. M ethods included a cross-sectional analysis of cervical cytology, colpo scopic impression, and histology in 248 HIV-infected women and multiva riate analyses of risk factors for abnormal cytology in 253 HIV-infect ed and 220 uninfected women and risk factors for CIN in 186 HIV-infect ed women. Results. The sensitivity and specificity of cytology for all CIN grades were 0.60 and 0.80 and, for high-grade GIN, 0.83 and 0.74. The prevalence of abnormal cytology was 32.9% in HIV-infected and 7.6 % in HIV-negative women. Independent risk factors for abnormal cytolog y were immunodeficiency [odds ratio (OR) 8-17, P < 0.001] and human pa pillomavirus (HPV) infection (OR = 5, P < 0.001). The prevalence of CI N on histology was 32% in HIV-infected women, and the only independent risk factor for CIN was oncogenic HPV type (OR = 5, P = 0.005). Concl usion. Given the high prevalence of abnormal cytology and CIN in HIV-i nfected women, cytologic screening has significant limitations. Both i mmunodeficiency and type of HPV infection are important risk factors. (C) 1998 Academic Press.