Human papillomavirus testing in primary screening for cervical cancer of human immunodeficiency virus-infected women, 1990-1998

Objective. Women infected with the human immunodeficiency virus (HIV) have an increased risk of cervical neoplasia while the value of cytologic screen ing is limited due to a high prevalence of inflammatory disease. The study was conducted to determine whether testing for human papillomavirus (HPV) D NA could improve primary screening for cervical cancer of these patients. Methods. One hundred thirty-eight HIV-infected women were examined between 1990 and 1998. Ninety-four patients with a total of 279 women-years were el igible for incidence evaluation. Colposcopy, cytology, and HPV DNA testing with the hybrid capture I assay were performed at each visit. Results. Seventeen cases of high-grade cervical neoplasia were diagnosed at study entry and 13 developed CIN II or CIN III during follow-up. The hybri d capture I assay detected 94.1% of prevalent and 100% of incident high-gra de neoplasia, while the corresponding sensitivity of Pap smears using CIN I or worse as the referral criteria was 82.3% for prevalent and 69.2% for in cident high-grade neoplasia, Eleven of 13 patients who progressed to histol ogically confirmed CIN II/III tested positive for HPV DNA at study entry co mpared with 5/13 women presenting with any degree of cytologic atypia at re cruitment. The Pap smears of 36/94 women remained normal throughout the stu dy while 54/94 patients remained negative for high-risk HPV types. Conclusion. Hybrid capture I identified high-grade cervical neoplasia more accurately than the Pap smear and appeared to be beneficial for primary cer vical cancer screening in HIV-infected women. (C) 1999 Academic Press.