Evolution of cervical abnormalities among women with HIV-1: Evidence from surveillance cytology in the women's interagency HIV study

Objective: To determine incidence, progression, and regression rates for ab normal cervical cytology and their correlates among women with HIV. Methods: In a multicenter prospective cohort study conducted October 1, 199 4, through September 30, 1999 at university, public, and private medical ce nters and clinics, 1639 HIV-seropositive and 452 seronegative women were ev aluated every 6 months for up to 5 years using history, cervical cytology, T-cell subsets, and quantitative plasma HIV RNA. Human papillomavirus (HPV) typing at baseline was determined by polymerase chain reaction. Cytology w as read using the Bethesda system, with any smear showing at least atypia c onsidered abnormal. Poisson regression identified factors associated with i ncident cytologic abnormalities whereas logistic regression identified thos e associated with progression and regression after an abnormality. Results: At least one abnormal smear was found during all of follow-up amon g 73.0% of HIV-seropositive patients and 42.3% of seronegatives (p < .001). Only 5.9% of seropositives ever developed high-grade lesions, and the prop ortion with high-grade findings did not rise over time. Incidence of atypic al squamous cells of uncertain significance (ASCUS) or more severe lesions among HIV-seropositive patients and seronegative patients was 26.4 and 11.0 /100 woman-years (rate ratio [RR], 2.4; 95% confidence interval [CI], 1.9-3 .0), whereas that of at least low-grade squamous intraepithelial lesions (S IL) was 8.9 and 2.2/100 (RR, 4.0; Cl, 2.6-6.1). HIV status, detection of th e presence of human papillomavirus (HPV), CD4 lymphocyte count, and HIV RNA level predicted incidence of abnormal cytology (p < .05); HPV detection an d HIV RNA level predicted progression (p < .01); and HPV detection, CD4 lym phocyte count, and HIV RNA level predicted regression (p < 00.1). Rates of incidence, progression, and regression of abnormal cytology did not differ between HIV seronegative women and seropositive women with CD4 lymphocyte c ounts > 200/mm(3) and HIV RNA levels < 4000/ml of similar HPV status. Conclusions: Although HIV infected women were at high risk for abnormal cyt ology, high-grade changes were uncommon. HIV status, HPV detection, CD4 lym phocyte count, and HIV RNA level predicted the incidence of cervical cytolo gic abnormalities. Progression was significantly increased only among the m ost immunosuppressed women, while regression was significantly reduced in a ll HIV seropositive women except those with the best controlled HIV disease .