The predictive value of cytologic testing in women with the human immunodeficiency virus who have low-grade squamous cervical lesions: A substudy of a randomized, phase III chemoprevention trial

Robinson, William R.; Luck, Mindy; Kendall, Michelle A.; Darragh, Teresa M.

doi:10.1067/mob.2003.205

Cited by 11 publications

(5 citation statements)

References 20 publications

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“…The guidelines for cervical screening of HIV-infected women are controversial; some investigators recommend only Pap smear screening, 16,17 whereas others prefer Pap smear and biopsy. 4,18 In our study, Pap smears performed well, and 73% of the subjects had LSIL or HSIL in Pap smear taken at the time of diagnosis of CIN. Moreover, the sensitivity and specificity of Pap smear in the detection of CIN were similar to those seen among healthy women in the greater Helsinki area.…”

Section: Discussionsupporting

confidence: 53%

Risk factors, diagnosis and prognosis of cervical intraepithelial neoplasia among HIV-infected women

2008

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The prevalence of cervical intraepithelial neoplasia (CIN) is high among HIV-infected women. Decreased CD4 lymphocytes, high human immunodeficiency viral load (HIVL) and human papillomavirus (HPV) infection are risk factors for CIN. We characterized the prevalence, risk factors and prognosis of histologically-verified CIN among systematically followed HIV-infected women enrolled from a low HIV-prevalence population. The study population comprised 153 HIV-infected women followed between 1989 and 2006. The mean +/- SD duration of follow-up was 5.6 +/- 3.8 years. Demographic as well as treatment-related data were derived from medical reports. During the follow-up, 51 subjects (33%) displayed CIN (16% CIN 1 and 18% CIN 2 +), whereas 102 subjects had Pap smear results of normal cells, atypical squamous cells of uncertain significance, or signs of low-grade squamous intraepithelial lesion (LSIL) but no CIN in histological specimens from the cervix. Only one case of cancer of the uterine cervix was detected. Pap smears were reliable in screening for CIN; 75% of patients with CIN had high-grade squamous intraepithelial lesion (HSIL) or LSIL in Pap smears taken at the time of dysplasia. The incidence of CIN decreased from 12.7 to 3.5 (per 100 subjects) between 2000 and 2005 (P = 0.07). The risk of CIN was not associated with decreased levels of CD4 lymphocytes, duration of HIV infection, use of antiretroviral medication or plasma HIVL. In univariate analysis, bacterial vaginosis (BV) was associated with a significantly increased risk of CIN, whereas parity was associated with lower risk of CIN. Each delivery lowered the risk of CIN by 30% (P = 0.02). The significantly lower risk of CIN among parous women (P = 0.04) persisted in multivariate analysis. CIN was treated by means of loop electrosurgical excision procedure (LEEP), (n = 34). The recurrence rate was low; seven subjects (14%) had a recurrence of CIN during follow-up. The nadir of CD4 lymphocytes was lower (P = 0.04) and the HIVL higher (P = 0.03) among subjects with recurrence of CIN. Duration of HIV infection, use of antiretroviral medication and positive margins in LEEP specimens were indistinguishable among subjects with vs. without recurrence of CIN. The prevalence of CIN is high among systematically managed HIV-infected women. However, the incidence of CIN decreased during the 21st century. BV was associated with an increased risk of CIN whereas parous women had lower risk of CIN. However, the patients with and without CIN could not be distinguished on the basis of previously described risk factors. Regular follow-up by means of Pap smears is warranted in all HIV-infected women.

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Section: Discussionsupporting

confidence: 53%

Risk factors, diagnosis and prognosis of cervical intraepithelial neoplasia among HIV-infected women

2008

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“…18 Similarly, some studies in women with secondary immunodeficiency, particularly those who were HIV seropositive, reported sensitivity of cytologic testing varying from 3.1–19.0%. 19,20 The false-negative rate found in our study has been reported in HIV patients. 21 The corresponding positive and negative LR were 6.0 and 0.8, respectively.…”

Section: Discussionsupporting

confidence: 63%

Comparing cytology, colposcopy and human papillomavirus cervical intraepithelial lesion screening methods in women with systemic lupus erythematosus

Garcı́a-Carrasco

Méndez‐Martínez

Rodríguez-Reyes

et al. 2020

Lupus

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Objective To compare the performance of cytology, colposcopy and human papillomavirus in detecting cervical intraepithelial lesions in women with systemic lupus erythematosus. Methods Papanicolaou smears (normal, low-grade squamous intraepithelial lesion, high grade squamous intraepithelial lesion), colposcopy findings, human papillomavirus and co-testing (Papanicolaou smear + human papillomavirus) were compared with cervical biopsy findings in women with systemic lupus erythematosus. Sensitivity, specificity, false-positive and false-negative rates, positive and negative predictive values and likelihood ratios of cytologic smears, colposcopy findings, human papillomavirus and co-testing were determined. Results Cytology and colposcopy were performed in 170 systemic lupus erythematosus women (mean age and disease duration of 43.7±12.1 years and 9.7±5.3 years, respectively) and biopsies were performed in 55 patients (38.2% normal, 60.0% low-grade squamous intraepithelial lesion and 1.8% high grade squamous intraepithelial lesion). The sensitivity, specificity, positive predictive value and negative predictive value of cytology were 14.7% (95% confidence interval 5.5–31.8%), 95.2% (95% confidence interval 74.1–99.7%), 83.3% (95% confidence interval 36.4–99.1%) and 40.8% (95% confidence interval 27.3–55.7%), respectively. The sensitivity, specificity and positive predictive value of colposcopy findings were 100.0% (95% confidence interval 87.3–100.0%), 0.0% (95% confidence interval 0.0–19.2%) and 61.8% (95% confidence interval 47.7–74.2%), respectively. The sensitivity and specificity of co-testing were 8.0% (95% confidence interval 1.3–27.5%) and 100.0% (95% confidence interval 71.6–100.0%). The positive predictive value and negative predictive values were 100.0% (95% confidence interval 19.7–100.0%) and 36.1% (95% confidence interval 33.5–38.8%), respectively. Conclusions In systemic lupus erythematosus patients, colposcopy impressions were more sensitive than cytology and co-testing. However, cytology and co-testing were the most specific tests. The results should be interpreted with caution due to the small sample size.

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“…Note that PPV applies to both VIA and histologic evaluation, such that the average estimate of 0.5 reflects that only 50% of VIA-positive women were truly diseased, and 50% of women undergoing histologic evaluation had some CIN lesions. The estimate of 1 for early- and late-stage cancers is used since the combination of histological and clinical staging procedures plus the low inter/intra-observer variability associated with the histologic diagnosis of invasive cancer assumes some stage of cancers is present (hence all women seen for staging have confirmed cancer on histologic evaluation, hence PPV of 1). § Adapted from [8,18–22]; ‘Adapted from [22–25]. …”

Section: Figurementioning

confidence: 99%

Implementation of Cervical Cancer Prevention Services for HIV-Infected Women in Zambia: Measuring Program Effectiveness

Parham¹,

Mwanahamuntu

Sahasrabuddhe

et al. 2010

HIV Ther.

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Background Cervical cancer kills more women in low-income nations than any other malignancy. A variety of research and demonstration efforts have proven the efficacy and effectiveness of low-cost cervical cancer prevention methods but none in routine program implementation settings of the developing world, particularly in HIV-infected women. Methods In our public sector cervical cancer prevention program in Zambia, nurses conduct screening using visual inspection with acetic acid aided by digital cervicography. Women with visible lesions are offered same-visit cryotherapy or referred for histologic evaluation and clinical management. We analyzed clinical outcomes and modeled program effectiveness among HIV-infected women by estimating the total number of cervical cancer deaths prevented through screening and treatment. Results Between 2006 and 2008, 6572 HIV-infected women were screened, 53.6% (3523) had visible lesions, 58.5% (2062) were eligible for cryotherapy and 41.5% (1461) were referred for histologic evaluation. A total of 75% (1095 out of 1462) of patients who were referred for evaluation complied. Pathology results from 65% (715 out of 1095) of women revealed benign abnormalities in 21% (151), cervical intraepithelial neoplasia (CIN) I in 30% (214), CIN 2/3 in 33% (235) and invasive cervical cancer in 16.1% (115, of which 69% were early stage). Using a conditional probability model, we estimated that our program prevented 142 cervical cancer deaths (high/low range: 238–96) among the 6572 HIV-infected women screened, or one cervical cancer death prevented per 46 (corresponding range: 28–68) HIV-infected women screened. Conclusion Our prevention efforts using setting-appropriate human resources and technology have reduced morbidity and mortality from cervical cancer among HIV-infected women in Zambia. Financial support for implementing cervical cancer prevention programs integrated within HIV/AIDS care programs is warranted. Our prevention model can serve as the implementation platform for future low-cost HPV-based screening methods, and our results may provide the basis for comparison of programmatic effectiveness of future prevention efforts.

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The predictive value of cytologic testing in women with the human immunodeficiency virus who have low-grade squamous cervical lesions: A substudy of a randomized, phase III chemoprevention trial

Cited by 11 publications

References 20 publications

Risk factors, diagnosis and prognosis of cervical intraepithelial neoplasia among HIV-infected women

Risk factors, diagnosis and prognosis of cervical intraepithelial neoplasia among HIV-infected women

Comparing cytology, colposcopy and human papillomavirus cervical intraepithelial lesion screening methods in women with systemic lupus erythematosus

Implementation of Cervical Cancer Prevention Services for HIV-Infected Women in Zambia: Measuring Program Effectiveness

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