Yield of Screening Colposcopy Among Human Immunodeficiency Virus-Infected Women

Abstract

Background. Among women infected with the human immunodeficiency virus, the high frequency of cervical intraepithelial neoplasia (CIN) may justify screening colpo-scopy. Methods. Screening colposcopy with cytology and biopsy were performed in 76 women enrolling in the Chicago Consortium of the Women’s Interagency Human Immunodeficiency Virus Study. Cytological smears and biopsies were read centrally. Potential risk factors for CIN were assessed. Results. Squamous intraepithelial lesion (SIL) was identified in 13% of women, and CIN1 was identified in 17%. No higher-grade CIN was found. The sensitivity of cytology in identifying CIN1 was 62%, specificity was 65%, positive predictive value was 27%, and negative predictive value was 89%. The sensitivity in SIL was 15%, the specificity was 87%, the positive predictive value was 20%, and the negative predictive value was 83%. Predictors of CIN in a multivariate model included a cytology result of atypical squamous cell of undetermined significance or worse (odds ratio versus benign smear result = 6.6; p < .04) and a history of trading sex for money or drugs (odds ratio versus no such history = 18.4; p < .02). Conclusions. In the population studied, the prevalence of CIN is low, and cytology alone appears to be adequate as a screen.