HISTOLOGY CYTOLOGY DISCREPANCIES IN HIV-INFECTED OBSTETRIC PATIENTS WITH NORMAL PAP SMEARS/

Objective. To estimate the frequency of cervical cytologic/histologic discrepancies in a group of obstetric patients diagnosed as HIV infect ed by routine prenatal screening. Also, to determine if serum CD4 leve ls or sexually transmitted diseases (STDs) are associated with the occ urrence of preinvasive cervical disease in these women. Method. Thirty -two women who presented for routine prenatal care to Medical Center o f Louisiana were diagnosed as HIV infected by ELISA and Western blot t esting and had normal Pap smears. These patients then agreed to underg o the following: colposcopy with directed biopsies; chlamydia, gonorrh ea, and syphilis screening; and serum CD4 level. Results. No patients had AIDS-defining diagnoses other than CD4 < 200/mm(3). Ten of 32 (31% ) had cervical intraepithelial neoplasia (GIN) despite normal cytology . Six of 32 (19%) had STDs. One of 10 in the group with CIN had a STD. The mean CD4 level in those patients with CIN was 249/mm(2) (range 1- 524) vs 501/mm(2) (range 210-979) in those without GIN. (P = 0.0118) C onclusions. Newly diagnosed HIV-infected pregnant women without clinic al evidence of AIDS are noted to have CIN at a rate similar to nonpreg nant HIV-infected women. The Pap smear appears to have a significant f alse-negative rate in this group. STDs, while common, were not directl y associated with false-negative Pap smears. CIN is associated with im munosuppression, as measured by low CD4 counts. (C) 1997 Academic Pres s.