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Obstetrics & Gynecology 2005;106:525-532
© 2005 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Outcome After Negative Colposcopy Among Human Immunodeficiency Virus–Infected Women With Borderline Cytologic Abnormalities

L. Stewart Massad, MD1, Charlesnika T. Evans, MPH2, Howard D. Strickler, MD, MPH3, Robert D. Burk, MD3, D. Heather Watts, MD4, Lorraine Cashin, MPS5, Teresa Darragh, MD6, Stephen Gange, PhD7, Yi-Chun Lee, MD8, Michael Moxley, MD9, Alexandra Levine10 and Douglas J. Passaro, MD, MPH2

From the 1Southern Illinois University School of Medicine, Springfield, Illinois; 2University of Illinois, Chicago, Illinois; 3Albert Einstein College of Medicine, Bronx, New York; 4National Institute of Child Health and Human Development, Bethesda, Maryland; 5Montefiore Medical Center, Bronx, New York; 6University of California, San Francisco, California; 7Johns Hopkins School of Public Health, Baltimore, Maryland; 8State University of New York, Brooklyn, New York; 9Georgetown University School of Medicine, Washington, DC; and 10Keck School of Medicine, University of Southern California, Los Angeles, California.

Objective: To estimate the risk of and risk factors for progression among human immunodeficiency virus (HIV)-seropositive women with abnormal cervical cytology but negative colposcopy.

Methods: In a prospective cohort study, 391 HIV-seropositive and 103 seronegative women with cervical cytology read as atypical squamous cells (ASC) or low-grade squamous intraepithelial lesion (LSIL) but negative colposcopy were followed up for a mean of 4.0 years with cytology at 6-month intervals. Colposcopy was prescribed for any epithelial abnormality.

Results: Progression to CIN2, CIN3, high-grade SIL/severe dysplasia, or cancer occurred in 47 (12%) HIV-seropositive women and 4 (4%) HIV-seronegative women (P = .02). Progression to CIN1 was seen in an additional 12 HIV-seropositive women and 1 seronegative woman. In multivariate analysis, high-risk but not low-risk HPV detection (hazard ratio [HR] 2.46–95% confidence interval [CI] 1.18–5.12, P = .02 for high risk, HR 1.41, 95% CI 0.62–3.21, P = .42 for low risk), satisfactory colposcopy (HR 2.01, 95% CI 1.11–3.65, P = .02), and non-Hispanic African-American ethnicity (HR 5.08, 95% CI 1.72–14.98, P = .003) were the only factors associated with progression, while HIV serostatus was marginally significant (HR 2.53, 95% CI 0.85–7.50, P = .09).

Conclusion: Human immunodeficiency virus–seropositive women with negative colposcopy after borderline cytology face a higher risk of progression than seronegative women, but the absolute risk is low and becomes nonsignificant after controlling for HPV risk type, ethnicity, and colposcopic findings. Observation is appropriate.

Level of Evidence: II-2






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