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Squamous Cervical Lesions in Women With Human Immunodeficiency Virus

Long-Term Follow-up

From the ¹Washington University School of Medicine, St. Louis, Missouri; ²Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ³Montefiore Medical Center, Bronx, New York; ⁴University of California, San Francisco, California; ⁵Downstate Medical Center, Brooklyn, New York; ⁶Georgetown University, Washington, DC; ⁷Albert Einstein School of Medicine, Bronx, New York; and ⁸National Institute of Child Health and Human Development, Bethesda Maryland.

OBJECTIVE: To estimate the frequency of and trends in abnormal Pap test results in women with human immunodeficiency virus (HIV) and HIV-uninfected women.

METHODS: In a cohort study of HIV-infected and uninfected women, Pap tests were obtained every 6 months. Results of atypical squamous cells of undetermined significance (ASC-US) or worse were considered abnormal.

RESULTS: Over a median of 8.4 years, 23,843 Pap tests were obtained from 1,931 HIV-positive women with 6,828 Pap tests from 533 HIV-negative women (13 women seroconverted during the study). Among women with HIV, Pap test results were ASC-US in 4,462 (19%), low-grade squamous intraepithelial lesion (LSIL) in 3,199 (13%), high-grade squamous intraepithelial lesion (HSIL) in 267 (1%), and cancer in 11 (0.05%). The incidence of abnormal Pap test results was 179 in 1,000 person-years for HIV-positive and 75 in 1,000 person-years for HIV-negative women (incidence rate ratio 2.4, 95% confidence interval 2.0–2.8). The incidence of HSIL or cancer was 4.4 in 1,000 person-years for HIV-positive and 1.3 in 1,000 person-years for HIV-negative women (incidence rate ratio 3.4, 95% confidence interval 1.2–9.5).

CONCLUSION: Among women with HIV in a cervical cancer prevention program, Pap test abnormalities are common, but high-grade abnormalities are infrequent.

LEVEL OF EVIDENCE: II

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