The significance of ASCUS cytology in HIV-positive women

Objective. The aim of this study was to determine the incidence and severit y of dysplasia associated with a cytologic diagnosis of atypical cells of u ndetermined significance (ASCUS) in women infected with the human immunodef iciency virus (HIV), Methods. A cross-sectional analysis of cervical cytology, colposcopic impre ssion, and cervical biopsy results was performed on 261 HIV-positive women diagnosed with ASCUS. The prevalence and grade of histologically documented cervical intraepithelial neoplasia (CIN) was determined. Patients with CD4 counts above and below 200 cells/mm(3) were compared using chi(2) analysis to determine any effect: of worsening immunosuppression on the rates of as sociated dysplasia. Results. Seven hundred sixty-one Pap smears were performed during the study period. Two hundred nine (27%) were diagnosed as ASCUS. All patients (pts) received colposcopic evaluation. The incidence of human papilloma virus (H PV) effect, low-grade CIN (I), and high-grade CIN (II, III, and carcinoma i n situ) documented by cervical biopsy, cervical conization or endocervical curettings was 40, 17, and 15%, respectively. No cases of invasive cancer w ere found. These results are similar to those of previous cytohistologic st udies of ASCUS in HIV-untested populations. There was no significant differ ence in frequency or severity of CIN in pts with severe immunosuppression ( P = 0.4). Conclusion. A cytologic diagnosis of ASCUS in HIV-positive women identifies a group at significant risk for histologic abnormalities. The majority of pts will be diagnosed with HPV or low-grade GIN. HIV infection and severe i mmunosuppression do not appear to increase the frequency or severity of CIN associated with ASCUS, Given the 32% risk of associated GIN, all HIV-posit ive women with ASCUS cytology should undergo colposcopic evaluation, (C) 19 99 Academic Press.