Cervical co-testing for the early detection of intraepithelial neoplasia in HIV-positive women
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CONTEXT & OBJECTIVE: This study aimed to assess whether HIV+ women at Boston Medical Center had an increased likelihood of developing intraepithelial neoplastic changes in the up to 6 years following a normal Pap smear and negative HPV (Human Papillomavirus) test when compared to the general population. The development of the neoplastic changes was also compared in HIV+ women with positive or negative HPV results. DESIGN & SETTING: We performed a retrospective chart review of the patient records of HIV+ women at Boston Medical Center. METHODS: HIV+ women, aged ¡Ý 30, screened between 2008-2010, with a normal cervical cytology result (Negative for Intraepithelial Lesion or Malignancy) and a concurrent HPV testing result and at least one subsequent cytology result were identified through the electronic medical record data warehouse at a single institution. These women were divided into two groups based on their HPV test result, either positive or negative. The medical records of these women were then evaluated through the end of 2014. The primary endpoint was the diagnosis of CIN-2 or 3, and the secondary endpoint was the diagnosis of other high-grade anogenital dysplasia. We examined the distribution of outcomes with a Chi-squared test or Fischer¡¯s test for discrete values and Student t-test for continuous data. Logistic regression analysis was performed to evaluate the relationship between variables and control for confounders like age and ethnicity. The crude and adjusted Odds Ratios (OR) were calculated and presented. We considered p-value < 0.05 to be statistically significant. RESULTS: 378 HIV+ women were identified- 307 women were HPV-negative, and 71 patients were HPV-positive at baseline. Women ranged in age from 30-81 years. HPV-negative patients had a mean age of 47¡À9, and HPV-positive patients had a slightly higher mean age of 49¡À9 at time of final evaluation. A total of eight (2%) women developed CIN-2, and five (62.5%) of them were HPV- positive at baseline (p-value of 0.001). Three individuals developed CIN-3, and two (66%) of them were also HPV-positive at baseline (p-value of 0.03). 23 (6.1%) individuals received at least one abnormal histology result, and of these, 13 (56.5%) were HPV-positive at baseline. After adjusting for age and race/ethnicity, there was still a significant difference of CIN-2/3 in HPV-positive compared to the HPV-negative group (OR 5.64 95%CI1.2-26.1), p<0.03). CONCLUSION: The results demonstrated that the likelihood of the development of CIN-2/3 in HIV+ women with normal pap tests and a positive HPV co-test is significantly higher in comparison to HIV+ women with a normal pap test and a negative HPV co-test. Therefore, HIV+ women with negative HPV tests had a greater incidence of CIN-3 than the general population (0.3% compared to 0.16%). Although HIV+ women with a negative HPV co-test are less likely to develop CIN-2/3 than HIV+ women a positive HPV co-test, a negative HPV test result is not as reassuring against the development of CIN-2/3 in HIV+ populations as it is in the general population.