The role of human papillomavirus deoxyribonucleic acid assay and repeated cervical cytologic examination in the detection of cervical intraepithelialneoplasia among human immunodeficiency virus-infected women
Ja. Cohn et al., The role of human papillomavirus deoxyribonucleic acid assay and repeated cervical cytologic examination in the detection of cervical intraepithelialneoplasia among human immunodeficiency virus-infected women, AM J OBST G, 184(3), 2001, pp. 322-330
OBJECTIVES: We sought to measure the characteristics of a quantitative huma
n papillomavirus deoxyribonucleic acid assay and repeated cervical cytologi
c examination in screening for cervical intraepithelial neoplasia among hum
an immunodeficiency virus-infected women.
STUDY DESIGN: Human immunodeficiency virus-infected women with screening CD
4+ lymphocyte counts of less than or equal to 500 cells/mm(3) (n = 103) wer
e examined by quantitative human papillomavirus deoxyribonucleic acid assay
and serial cervical cytologic examination and by colposcopy with biopsy an
d endocervical curettage during the course of 1 year.
RESULTS: Quantitative measures of total human papillomavirus deoxyribonucle
ic acid and high-risk human papillomavirus deoxyribonucleic acid were stron
gly associated with any cervical intraepithelial neoplasia (P=.005) and hig
h-grade cervical intraepithelial neoplasia (P=.0006), but they improved the
sensitivity and negative predictive value of baseline screening only sligh
tly when combined with cervical cytologic examination. Incident cervical in
traepithelial neoplasia occurred frequently (20%) during 1 year of follow-u
p and was more common among human papillomavirus-infected women. Repeated c
ytologic examination identified 60% of women with new cervical intraepithel
ial neoplasia.
CONCLUSION: Human immunodeficiency virus-infected women with at least mild
immunosuppression have a high incidence of cervical intraepithelial neoplas
ia, which warrants close follow-up. Those with high baseline human papillom
avirus deoxyribonucleic acid levels may be at the highest risk for incident
cervical intraepithelial neoplasia.