Cohn J, Gagnon S, Spence M, Harrison D, Kluzak T, Langenberg P, Brinson C, Stein A, Hellinger J; National Conference on Women & HIV.

Natl Conf Women HIV Natl Conf Women HIV Innov Care Policy Prev 1997 Los Angel Calif. 1997 May 4-7; 126 (abstract no. 203.1).

Wayne State University, School of Medicine, Detroit, MI.

Objectives: We investigated the effect of combining a commercially available quantitative HPV DNA assay with routine Pap smears in screening for CIN among HIV-infected women with at least mild immunosuppression. Methods: 109 HIV-infected women with CD4+ lymphocyte counts less than or equal to 500 were enrolled in 6 US cities. Every six months, each woman underwent a detailed history and gynecologic exam, including Pap smear performed with a cytobrush, cervical swab for quantitative determination of HPV DNA of both low-risk and high-risk HPV types using the Hybrid Capture technique (Digene Diagnostics, Gaithersburg Maryland), and colposcopy with at least two cervical biopsies and endocervical curettage. Pap smears and biopsies were read by both local cytopathologists, and by a single central cytopathologist masked to the local readings. Results are presented with exact 95% confidence intervals. Results: Data are available for 101 women for their first (cross-sectional) visit. On biopsy/ECC, 27 women had CIN and 10 women had high grade CIN. There was a strong association between quantity of total HPV DNA and CIN (p=0.005), and between high-risk HPV DNA and high grade CIN (p=0.03) by the Wilcoxon-Mann-Whitney test. Cut points at increasing quantities of total HPV DNA (and high-risk HPV DNA) provided higher sensitivity and negative predictive value for CIN (and high grade CIN), at a cost of reduced specificity and positive predictive value. The combination of an abnormal Pap smear (any epithelial cell abnormality) and a heavy HPV infection (defined as the top third of quantitative HPV DNA results obtained in these women) improved sensitivity and negative predictive value slightly, compared with Pap smears alone. (Table: see text) Conclusions: Increased quantities of HPV DNA (and high risk HPV DNA) are strongly and significantly associated with CIN (and high grade CIN) among HIV-infected women. In this pilot study, adding a quantitative HPV DNA assay to routine Pap smears marginally increased the negative predictive value in screening for CIN or high grade CIN. This assay may be of greater value in the interpretation of borderline cytologic abnormalities, or in predicting the future behavior of low grade lesions.

Publication Types:

• Meeting Abstracts

Keywords:

• AIDS Vaccines
• Acquired Immunodeficiency Syndrome
• Cervical Intraepithelial Neoplasia
• Cervix Uteri
• Colposcopy
• DNA
• DNA Probes, HPV
• DNA, Viral
• Female
• HIV Infections
• HIV Seropositivity
• Humans
• Maryland
• Mass Screening
• Papillomaviridae
• Sensitivity and Specificity
• Vaginal Smears
• diagnosis

Other ID:

• 97927290

UI: 102225880

From Meeting Abstracts