Accuracy of Papanicolaou Test among HIV-Infected Women

Abstract

We examined the accuracy of the Papanicolaou (Pap) test among women with and women at high risk for human immunodeficiency virus (HIV) infection. Pap test results and colposcopy findings were compared for 189 HIV-infected women and 95 HIV-uninfected women from the Baltimore HIV Epidemiology Research (HER) study site who were followed up semiannually from 1993 through 1999. Correlations were examined using data from individual visits that were analyzed using generalized estimating equation methods. Among women with normal results of Pap tests who underwent biopsy, the likelihood of cervical intraepithelial neoplasia was significantly greater for HIV-infected women (14.3%) than for HIV-uninfected women (1.2%) (P < .01). The specificity and negative predictive value of Pap testing were higher among HIV-uninfected women, regardless of whether detection of atypical squamous cells of undetermined significance was considered to be abnormal. Independent predictors of discordant cytologic and histologic findings included detection of human papillomavirus (adjusted odds ratio [OR], 3.1; 95% confidence interval [CI], 1.0-9.8) and a CD4 cell count of < 500 cells/microL (adjusted OR, 6.5; 95% CI, 1.5-29.2). Of the 19 HIV-infected women with normal cytologic findings and cervical intraepithelial neoplasia, 18 had abnormal Pap test findings (most often atypical squamous cells of undetermined significance) within 1 year of discordant cytologic and histologic findings. In this well-described cohort of women with and women at high risk for HIV infection, agreement between cytologic findings and colposcopic and histologic findings was high. A small number of HIV-infected women had cervical intraepithelial neoplasia, despite having normal cytologic findings; 95% of these women would have had cytologic abnormalities detected within 1 year of the discordant results by use of current guidelines for Pap test screening. These data fail to support the need for routine colposcopy in all HIV-infected women.