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OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
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 T. C. Wright Jr, J. T. Cox, L. S. Massad, L. B. Twiggs, E. J. Wilkinson, and for the 2001 ASCCP-Sponsored Consensus Conference 2001 Consensus Guidelines for the Management of Women With Cervical Cytological Abnormalities JAMA, April 24, 2002; 287(16): 2120 - 2129. [Abstract] [Full Text] [PDF]
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 S. J. Goldie, M. C. Weinstein, K. M. Kuntz, and K. A. Freedberg The Costs, Clinical Benefits, and Cost-Effectiveness of Screening for Cervical Cancer in HIV-Infected Women Ann Intern Med, January 19, 1999; 130(2): 97 - 107. [Abstract] [Full Text] [PDF]
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M. J. Fink, A. Goodman, E. Hight, E. Miller-Mack, and A. De Groot Critical Prevention, Critical Care: Gynecological and Obstetrical Aspects of Comprehensive HIV Prevention and Treatment Among Incarcerated Women Journal of Correctional Health Care, October 1, 1998; 5(2): 201 - 223. [Abstract] [PDF]
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