Outcome after negative colposcopy among human immunodeficiency virus-infected women with borderline cytologic abnormalities

L. Stewart Massad, Charlesnika T. Evans, Howard Strickler, Robert D. Burk, D. Heather Watts, Lorraine Cashin, Teresa Darragh, Stephen Gange, Yi Chun Lee, Michael Moxley, Alexandra Levine, Douglas J. Passaro

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: To estimate the risk of and risk factors for progression among human immunodeficiency virus (HIV)-seropositive women with abnormal cervical cytology but negative colposcopy. Methods: In a prospective cohort study, 391 HIV-seropositive and 103 seronegative women with cervical cytology read as atypical squamous cells (ASC) or low-grade squamous intraepithelial lesion (LSIL) but negative colposcopy were followed up for a mean of 4.0 years with cytology at 6-month intervals. Colposcopy was prescribed for any epithelial abnormality. Results: Progression to CIN2, CIN3, high-grade SIL/severe dysplasia, or cancer occurred in 47 (12%) HIV-seropositive women and 4 (4%) HIV-seronegative women (P = .02). Progression to CIN1 was seen in an additional 12 HIV-seropositive women and 1 seronegative woman. In multivariate analysis, high-risk but not low-risk HPV detection (hazard ratio [HR] 2.46-95% confidence interval [CI] 1.18-5.12, P = .02 for high risk, HR 1.41, 95% CI 0.62-3.21, P = .42 for low risk), satisfactory colposcopy (HR 2.01, 95% CI 1.11-3.65, P = .02), and non-Hispanic African-American ethnicity (HR 5.08, 95% CI 1.72-14.98, P = .003) were the only factors associated with progression, while HIV serostatus was marginally significant (HR 2.53, 95% CI 0.85-7.50, P = .09). Conclusion: Human immunodeficiency virus-seropositive women with negative colposcopy after borderline cytology face a higher risk of progression than seronegative women, but the absolute risk is low and becomes nonsignificant after controlling for HPV risk type, ethnicity, and colposcopic findings. Observation is appropriate.

Original languageEnglish (US)
Pages (from-to)525-532
Number of pages8
JournalObstetrics and Gynecology
Volume106
Issue number3
StatePublished - Sep 2005
Externally publishedYes

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Colposcopy
HIV
Cell Biology
Confidence Intervals
African Americans
Cohort Studies
Multivariate Analysis
Odds Ratio
Observation
Prospective Studies

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Outcome after negative colposcopy among human immunodeficiency virus-infected women with borderline cytologic abnormalities. / Massad, L. Stewart; Evans, Charlesnika T.; Strickler, Howard; Burk, Robert D.; Watts, D. Heather; Cashin, Lorraine; Darragh, Teresa; Gange, Stephen; Lee, Yi Chun; Moxley, Michael; Levine, Alexandra; Passaro, Douglas J.

In: Obstetrics and Gynecology, Vol. 106, No. 3, 09.2005, p. 525-532.

Research output: Contribution to journalArticle

Massad, LS, Evans, CT, Strickler, H, Burk, RD, Watts, DH, Cashin, L, Darragh, T, Gange, S, Lee, YC, Moxley, M, Levine, A & Passaro, DJ 2005, 'Outcome after negative colposcopy among human immunodeficiency virus-infected women with borderline cytologic abnormalities', Obstetrics and Gynecology, vol. 106, no. 3, pp. 525-532.
Massad, L. Stewart ; Evans, Charlesnika T. ; Strickler, Howard ; Burk, Robert D. ; Watts, D. Heather ; Cashin, Lorraine ; Darragh, Teresa ; Gange, Stephen ; Lee, Yi Chun ; Moxley, Michael ; Levine, Alexandra ; Passaro, Douglas J. / Outcome after negative colposcopy among human immunodeficiency virus-infected women with borderline cytologic abnormalities. In: Obstetrics and Gynecology. 2005 ; Vol. 106, No. 3. pp. 525-532.
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abstract = "Objective: To estimate the risk of and risk factors for progression among human immunodeficiency virus (HIV)-seropositive women with abnormal cervical cytology but negative colposcopy. Methods: In a prospective cohort study, 391 HIV-seropositive and 103 seronegative women with cervical cytology read as atypical squamous cells (ASC) or low-grade squamous intraepithelial lesion (LSIL) but negative colposcopy were followed up for a mean of 4.0 years with cytology at 6-month intervals. Colposcopy was prescribed for any epithelial abnormality. Results: Progression to CIN2, CIN3, high-grade SIL/severe dysplasia, or cancer occurred in 47 (12{\%}) HIV-seropositive women and 4 (4{\%}) HIV-seronegative women (P = .02). Progression to CIN1 was seen in an additional 12 HIV-seropositive women and 1 seronegative woman. In multivariate analysis, high-risk but not low-risk HPV detection (hazard ratio [HR] 2.46-95{\%} confidence interval [CI] 1.18-5.12, P = .02 for high risk, HR 1.41, 95{\%} CI 0.62-3.21, P = .42 for low risk), satisfactory colposcopy (HR 2.01, 95{\%} CI 1.11-3.65, P = .02), and non-Hispanic African-American ethnicity (HR 5.08, 95{\%} CI 1.72-14.98, P = .003) were the only factors associated with progression, while HIV serostatus was marginally significant (HR 2.53, 95{\%} CI 0.85-7.50, P = .09). Conclusion: Human immunodeficiency virus-seropositive women with negative colposcopy after borderline cytology face a higher risk of progression than seronegative women, but the absolute risk is low and becomes nonsignificant after controlling for HPV risk type, ethnicity, and colposcopic findings. Observation is appropriate.",
author = "Massad, {L. Stewart} and Evans, {Charlesnika T.} and Howard Strickler and Burk, {Robert D.} and Watts, {D. Heather} and Lorraine Cashin and Teresa Darragh and Stephen Gange and Lee, {Yi Chun} and Michael Moxley and Alexandra Levine and Passaro, {Douglas J.}",
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T1 - Outcome after negative colposcopy among human immunodeficiency virus-infected women with borderline cytologic abnormalities

AU - Massad, L. Stewart

AU - Evans, Charlesnika T.

AU - Strickler, Howard

AU - Burk, Robert D.

AU - Watts, D. Heather

AU - Cashin, Lorraine

AU - Darragh, Teresa

AU - Gange, Stephen

AU - Lee, Yi Chun

AU - Moxley, Michael

AU - Levine, Alexandra

AU - Passaro, Douglas J.

PY - 2005/9

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N2 - Objective: To estimate the risk of and risk factors for progression among human immunodeficiency virus (HIV)-seropositive women with abnormal cervical cytology but negative colposcopy. Methods: In a prospective cohort study, 391 HIV-seropositive and 103 seronegative women with cervical cytology read as atypical squamous cells (ASC) or low-grade squamous intraepithelial lesion (LSIL) but negative colposcopy were followed up for a mean of 4.0 years with cytology at 6-month intervals. Colposcopy was prescribed for any epithelial abnormality. Results: Progression to CIN2, CIN3, high-grade SIL/severe dysplasia, or cancer occurred in 47 (12%) HIV-seropositive women and 4 (4%) HIV-seronegative women (P = .02). Progression to CIN1 was seen in an additional 12 HIV-seropositive women and 1 seronegative woman. In multivariate analysis, high-risk but not low-risk HPV detection (hazard ratio [HR] 2.46-95% confidence interval [CI] 1.18-5.12, P = .02 for high risk, HR 1.41, 95% CI 0.62-3.21, P = .42 for low risk), satisfactory colposcopy (HR 2.01, 95% CI 1.11-3.65, P = .02), and non-Hispanic African-American ethnicity (HR 5.08, 95% CI 1.72-14.98, P = .003) were the only factors associated with progression, while HIV serostatus was marginally significant (HR 2.53, 95% CI 0.85-7.50, P = .09). Conclusion: Human immunodeficiency virus-seropositive women with negative colposcopy after borderline cytology face a higher risk of progression than seronegative women, but the absolute risk is low and becomes nonsignificant after controlling for HPV risk type, ethnicity, and colposcopic findings. Observation is appropriate.

AB - Objective: To estimate the risk of and risk factors for progression among human immunodeficiency virus (HIV)-seropositive women with abnormal cervical cytology but negative colposcopy. Methods: In a prospective cohort study, 391 HIV-seropositive and 103 seronegative women with cervical cytology read as atypical squamous cells (ASC) or low-grade squamous intraepithelial lesion (LSIL) but negative colposcopy were followed up for a mean of 4.0 years with cytology at 6-month intervals. Colposcopy was prescribed for any epithelial abnormality. Results: Progression to CIN2, CIN3, high-grade SIL/severe dysplasia, or cancer occurred in 47 (12%) HIV-seropositive women and 4 (4%) HIV-seronegative women (P = .02). Progression to CIN1 was seen in an additional 12 HIV-seropositive women and 1 seronegative woman. In multivariate analysis, high-risk but not low-risk HPV detection (hazard ratio [HR] 2.46-95% confidence interval [CI] 1.18-5.12, P = .02 for high risk, HR 1.41, 95% CI 0.62-3.21, P = .42 for low risk), satisfactory colposcopy (HR 2.01, 95% CI 1.11-3.65, P = .02), and non-Hispanic African-American ethnicity (HR 5.08, 95% CI 1.72-14.98, P = .003) were the only factors associated with progression, while HIV serostatus was marginally significant (HR 2.53, 95% CI 0.85-7.50, P = .09). Conclusion: Human immunodeficiency virus-seropositive women with negative colposcopy after borderline cytology face a higher risk of progression than seronegative women, but the absolute risk is low and becomes nonsignificant after controlling for HPV risk type, ethnicity, and colposcopic findings. Observation is appropriate.

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