Cervical Intraepithelial Neoplasia Grade 2 or Worse in Human Immunodeficiency Virus–Infected Women With Mildly Abnormal Cervical Cytology

Abstract

To compare the prevalence of cervical intraepithelial neoplasia (CIN) 2 or worse in a cohort of human immunodeficiency virus (HIV)-positive and HIV-negative women with mildly abnormal cervical cytology. A cross-sectional cohort study was done using an established database of 3,013 women who underwent colposcopic evaluation between August 1999 and May 2006. Data collected included demographic information and cervical cytologic and histologic results. Descriptive statistics and crude and adjusted odds ratios with 95% confidence intervals were calculated. Of 103 HIV-infected women seen for colposcopy, 72 (70%) had atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL) on referral cytology. Human immunodeficiency virus-positive women with ASC-US or LSIL were then compared with a population of 360 HIV-negative women, matched by cytologic diagnosis (ASC-US or LSIL). Both populations were found to be at similar risk for CIN 2+ (11 or 72 or 15.2% of HIV-positive women compared with 48 of 360 or 13.3% of HIV-negative women; odds ratio [OR] 1.17, 95% confidence interval [CI] 0.58-2.39). After adjustment for age, race/ethnicity, insurance status, gravidity, current smoking, and sexually transmitted disease history, the odds of CIN 2+ in HIV-infected women remained unchanged (adjusted OR 0.88, 95% CI 0.35-2.18). In the HIV-infected cohort with known CD4 counts, CIN 2+ was more commonly found among women with CD4 less than 200 cells/microliter (4 of 10 or 40%) compared with women with CD4 200 or more (4 of 30 or 13%; OR 4.3, 95% CI 0.84-22.47). High-grade disease was encountered in approximately 15% of patients with ASCU-US or LSIL, irrespective of HIV status.