L Stewart Massad1, Xianhong Xie, Teresa M Darragh, Howard Minkoff, Alexandra M Levine, Gypsyamber D'Souza, Anthony Cajigas, Christine Colie, D Heather Watts, Howard D Strickler. 1. From the Washington University School of Medicine, Springfield, Illinois; Albert Einstein College of Medicine, Bronx, New York; University of California, San Francisco, California; Maimonides Medical Center, Brooklyn, New York; City of Hope National Medical Center, Duarte, California, and Keck School of Medicine, University of Southern California, Los Angeles, California; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Montefiore Medical Center, Bronx, New York; Georgetown University, Washington, DC; Eunice Kennedy Shriver National Institute for Child Health and Human Development, Bethesda, Maryland; Albert Einstein College of Medicine, Bronx, New York.
Abstract
OBJECTIVE: To estimate the frequency and histologic correlates of glandular abnormalities in cervical cytology among women with the human immunodeficiency virus (HIV) and to compare findings with those of women without HIV. METHODS: In a cohort study of HIV-infected and uninfected women followed between 1994 and 2007, Pap tests were obtained every 6 months. Glandular abnormalities, including atypical glandular cells (AGC), adenocarcinoma in situ (AIS), and adenocarcinoma, were identified and correlated with biopsy histology. Multivariate models to summarize data across visits used generalized estimating equations. The association of Pap and histology results was assessed using chi tests. RESULTS: Of 48,362 Pap tests from 3,766 women, glandular abnormalities were found in 341 (0.7%) tests from 244 (6%) women, including 93 (1.0%) of 9,564 Pap tests among HIV-seropositive women with CD4 lymphocyte counts less than 250/mm, 103 (0.8%) of 13,023 tests among those with counts 250-500/mm, 68 (0.6%) of 12,470 tests among women with counts greater than 500/mm, and 70 (0.6%) of 11,769 tests among HIV-seronegative women (P for trend=.006). Colposcopy was documented for only 148 (61%) of 244 index Pap tests in women with glandular abnormalities. After index abnormal tests, endocervical curettings were obtained from 106 (43%) women, cervical biopsies from 76 (38%), and endometrial biopsies from 19 (8%). Squamous lesions predominated among histologic findings and histology results did not differ by HIV serostatus (P=.16). CONCLUSION: Although immunosuppression increased the risk of glandular Pap test abnormalities in women with HIV, these remained uncommon. Compliance with management guidelines can improved. LEVEL OF EVIDENCE: II.
OBJECTIVE: To estimate the frequency and histologic correlates of glandular abnormalities in cervical cytology among women with the human immunodeficiency virus (HIV) and to compare findings with those of women without HIV. METHODS: In a cohort study of HIV-infected and uninfected women followed between 1994 and 2007, Pap tests were obtained every 6 months. Glandular abnormalities, including atypical glandular cells (AGC), adenocarcinoma in situ (AIS), and adenocarcinoma, were identified and correlated with biopsy histology. Multivariate models to summarize data across visits used generalized estimating equations. The association of Pap and histology results was assessed using chi tests. RESULTS: Of 48,362 Pap tests from 3,766 women, glandular abnormalities were found in 341 (0.7%) tests from 244 (6%) women, including 93 (1.0%) of 9,564 Pap tests among HIV-seropositivewomen with CD4 lymphocyte counts less than 250/mm, 103 (0.8%) of 13,023 tests among those with counts 250-500/mm, 68 (0.6%) of 12,470 tests among women with counts greater than 500/mm, and 70 (0.6%) of 11,769 tests among HIV-seronegative women (P for trend=.006). Colposcopy was documented for only 148 (61%) of 244 index Pap tests in women with glandular abnormalities. After index abnormal tests, endocervical curettings were obtained from 106 (43%) women, cervical biopsies from 76 (38%), and endometrial biopsies from 19 (8%). Squamous lesions predominated among histologic findings and histology results did not differ by HIV serostatus (P=.16). CONCLUSION: Although immunosuppression increased the risk of glandular Pap test abnormalities in women with HIV, these remained uncommon. Compliance with management guidelines can improved. LEVEL OF EVIDENCE: II.
Authors: J M Palefsky; H Minkoff; L A Kalish; A Levine; H S Sacks; P Garcia; M Young; S Melnick; P Miotti; R Burk Journal: J Natl Cancer Inst Date: 1999-02-03 Impact factor: 13.506
Authors: Melanie C Bacon; Viktor von Wyl; Christine Alden; Gerald Sharp; Esther Robison; Nancy Hessol; Stephen Gange; Yvonne Barranday; Susan Holman; Kathleen Weber; Mary A Young Journal: Clin Diagn Lab Immunol Date: 2005-09
Authors: H E Cejtin; E Komaroff; L S Massad; A Korn; J B Schmidt; D Eisenberger-Matiyahu; E Stier Journal: J Acquir Immune Defic Syndr Date: 1999-11-01 Impact factor: 3.731
Authors: Howard D Strickler; Robert D Burk; Melissa Fazzari; Kathryn Anastos; Howard Minkoff; L Stewart Massad; Charles Hall; Melanie Bacon; Alexandra M Levine; D Heather Watts; Michael J Silverberg; Xiaonan Xue; Nicolas F Schlecht; Sandra Melnick; Joel M Palefsky Journal: J Natl Cancer Inst Date: 2005-04-20 Impact factor: 13.506
Authors: S E Barkan; S L Melnick; S Preston-Martin; K Weber; L A Kalish; P Miotti; M Young; R Greenblatt; H Sacks; J Feldman Journal: Epidemiology Date: 1998-03 Impact factor: 4.822
Authors: Thomas C Wright; L Stewart Massad; Charles J Dunton; Mark Spitzer; Edward J Wilkinson; Diane Solomon Journal: J Low Genit Tract Dis Date: 2007-10 Impact factor: 1.925
Authors: L Stewart Massad; Eric C Seaberg; D Heather Watts; Howard Minkoff; Alexandra M Levine; Donna Henry; Christine Colie; Teresa M Darragh; Nancy A Hessol Journal: Cancer Date: 2009-02-01 Impact factor: 6.860