Document 2602
 DOCN  M94A2602
 TI    Comparison of cervical cytology with colposcopic biopsies in U.S.
       HIV-infected women.
 DT    9412
 AU    Gagnon S; Cohn J; Spence M; Harrison D; Brinson C; Stein A; Hellinger J;
       UKSM-W, Wichita.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(1):267 (abstract no. PB0499). Unique
       Identifier : AIDSLINE ICA10/94369973
 AB    OBJECTIVE: To compare Papanicolaou (PAP) smears to colposcopic
       evaluations in diagnosing precursors of cervical cancer in a broad cross
       section of immunosuppressed HIV-infected women. METHODS: HIV-infected
       women in 6 US cities with a CD4 count < or = 500, without prior cervical
       cancer or cervical dysplasia in the past two years were enrolled by
       their primary care providers into a cross sectional study. CD4 cell
       counts, PAP smears and colposcopic evaluations with mandatory biopsies
       were obtained on all women. RESULTS: Preliminary data are available on
       72 of 126 women. Median CD4 cell count was 272 (R, 10-578). On biopsy
       24% of women had cervical intraepithelial neoplasia (CIN), 6% had CIN II
       or III, and no women had cervical cancer. A suspicious PAP smear
       (containing either atypical cells, evidence of papilloma virus infection
       or squamous epithelial lesion) had a sensitivity for all CIN of 0.59,
       specificity of 0.78, a negative predictive value of 0.86 and a false
       negative rate of 0.41, but a sensitivity for CIN II or CIN III of 1.00,
       specificity of 0.73, a negative predictive value of 1.00 and a false
       negative rate of 0.00. CONCLUSION: In this group of HIV-infected,
       immunosuppressed women with a prevalence of CIN of 24%, a single PAP
       smear had more than a 40% false negative rate for all CIN but no cases
       of CIN II or III were missed. If progression of cervical disease is
       rapid in these women, a PAP smear may not been an adequate screen.
       Strategies of performing repeated PAP smears and comparing results with
       colposcopy over time will measure the rate of cervical disease
       progression and determine the most appropriate standard of gynecologic
       care for these women.
 DE    Cell Transformation, Neoplastic/PATHOLOGY  Cervical Intraepithelial
       Neoplasia/PATHOLOGY  Cervix Neoplasms/*PATHOLOGY  Cervix Uteri/PATHOLOGY
       *Colposcopy  Comparative Study  Cross-Sectional Studies  Female  Human
       HIV Infections/*PATHOLOGY  Neoplasm Staging  Precancerous
       Conditions/*PATHOLOGY  Risk Factors  Vaginal Smears  MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
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