Prevalence and predictors of squamous cell abnormalities in Papanicolaou smears from women infected with HIV-1

Cervical neoplasia occurs with increased frequency among women infected wit h HIV-1. Objective: To characterize prevalence of and risk factors for abnormal cerv ical cytology among women with HIV and to compare them to uninfected women. Methods: Baseline cervical cytology was obtained from 1713 women seroposit ive for HIV and 482 at-risk control women who were enrolled in the Women's Interagency HIV Study, a multicenter prospective cohort study conducted in six U.S. cities. Associations with sociodemographic, medical, and sexual va riables were assessed by Fisher's exact test, Mantel extension test, and lo gistic regression analysis. Results: Cervical cytology was abnormal in 38.3% of HIV-infected women (aty pical squamous cells of uncertain significance [ASCUS] 20.9%, low-grade squ amous cells of uncertain significance [LSIL] 14.9%, high-grade squamous cel ls of uncertain significance [HSIL] 2.3%, cancer 0.2%) and 16.2% of HIV-uni nfected women (ASCUS 12.7%, LSIL 2.3%, HSIL 1.2%, cancer 0.0%). Risk factor s for any abnormal cytology in multivariate analysis included HIV infection , CD4 cell count, HIV RNA level, detection of human papillomavirus (HPV), a prior history of abnormal cytology, employment, and number of male sex par tners within 6 months of enrollment. Prior abortion was associated with a d ecreased risk of cytologic abnormality. Conclusions: Cervical cytologic abnormalities were frequent among women inf ected with HIV, although high-grade changes were found in only 2.5%. Factor s linked to sexual and reproductive history, HPV infection, and HIV disease all influenced risk.