Papanicolaou smear abnormalities in HIV‐infected women in north India

Abstract

AbstractBackground: Dysplasia on Papanicolaou (Pap) smears have been reported in 15–40% of HIV‐positive women. These rates are 10–11 times higher than those observed among HIV‐negative women. Both the Center for Disease Control and Prevention and the Agency for Healthcare Policy and Research recommend that HIV‐infected women have a gynecologic evaluation including a Pap smear and pelvic examination as part of their initial evaluation.Methods: We performed pelvic examinations and took Pap smears in HIV‐positive women who attended the immunodeficiency clinic of the Postgraduate Institute of Medical Education and Research, Chandigarh, India, from August 2002 to September 2004. The cytology results were followed by colposcopy and/or biopsy if needed.Results: There were 136 women included in the study, and the age range was 21–58·years. Fourteen patients were menopausal, two had lactational amenorrhea, and five were pregnant. All were married and the majority (121 women) were parous. None of these women had any gynecologic symptoms. Speculum examination was clinically normal in 44 women, 24 had vaginal discharge suggestive of monilial vaginitis, 24 had vaginal discharge suggestive of a mixed infection and 44 had cervical erosion (with or without vaginitis). Bimanual pelvic examination was normal in nearly all, and only two had adnexal tenderness due to pelvic inflammatory disease. Pap smears were reported as normal in 65% of women and as inflammatory in 20%. Dysplasia was seen in 14 smears with invasive carcinoma in one. Seven women underwent colposcopic examination with directed biopsies where indicated. Despite initial counseling for a need for follow‐up, about one‐quarter of the women did not return to collect Pap smear reports and among this group were seven women with dysplasia.Conclusion: The high incidence of dysplasia in HIV‐positive women supports the recommendation of regular gynecologic examination including Pap smears in all these women even if they do not have any gynecologic symptoms. However, there is a need to have a better follow‐up so that appropriate therapeutic measures can be taken.