Significance of mild cytologic atypia in women infected with human immunodeficiency virus

Abstract

To determine the prevalence of cervical intraepithelial neoplasia (CIN) in women who are infected with human immunodeficiency virus (HIV) and who have mild cytologic atypia. As part of an ongoing, prospective study of cervical disease in HIV-infected women, Papanicolaou smears were analyzed cross-sectionally for the diagnosis of mild cytologic atypia. Mild cytologic atypia was diagnosed in 112 (25%) of the 453 HIV-infected women enrolled in this study, compared with 36 (9%) of the 401 HIV-uninfected women (odds ratio [OR] 3.3, 95% confidence interval [CI] 2.2-5.1; P < .001). Mild cytologic atypia was diagnosed more frequently in HIV-infected women with lower CD4+ T-lymphocyte counts (chi2 for trend, P = .015) and in those with a history of an abnormal Papanicolaou smear or treatment for cervical disease (OR 3.0, 95% CI 1.2-7.6; P = .008). Coexistent CIN was detected by colposcopically directed biopsy in 42 (38%) of the 112 HIV-infected women with mild cytologic atypia, compared with five (14%) of the 36 HIV-uninfected women (OR 3.7, 95% CI 1.3-11.9; P = .008). Severe inflammation with associated epithelial reparative atypia was diagnosed in 90 (20%) of the HIV-infected women and in 87 (22%) of the HIV-uninfected women. Coexistent CIN was detected in 12% of the HIV-infected women with severe inflammation and associated epithelial reparative atypia, compared with 2% of the HIV-uninfected women with this cytologic diagnosis (OR 5.9, 95% CI 1.2-23; P = .01). Mild cytologic atypia, a frequent diagnosis on Papanicolaou smears from HIV-infected women, is associated with CIN. We recommend that all HIV-infected women with mild cytologic atypia be referred for colposcopy.