Prevalence and predictors of squamous cell abnormalities in Papanicolaou smears from women infected with HIV-1

L. Stewart Massad, Katherine A. Riester, Kathryn M. Anastos, Rachel G. Fruchter, Joel M. Palefsky, Robert D. Burk, David Burns, Ruth M. Greenblatt, Laila I. Muderspach, Paolo Miotti

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


Background: Cervical neoplasia occurs with increased frequency among women infected with HIV-1. Objective: To characterize prevalence of and risk factors for abnormal cervical cytology among women with HIV and to compare them to uninfected women. Methods: Baseline cervical cytology was obtained from 1713 women seropositive for HIV and 482 at-risk control women who were enrolled in the Women's Interagency HIV Study, a multicenter prospective cohort study conducted in six U.S. cities. Associations with sociodemographic, medical, and sexual variables were assessed by Fisher's exact test, Mantel extension test, and logistic regression analysis. Results: Cervical cytology was abnormal in 38.3% of HIV-infected women (atypical squamous cells of uncertain significance [ASCUS] 20.9%, low-grade squamous cells of uncertain significance [LSIL] 14.9%, high-grade squamous cells of uncertain significance [HSIL] 2.3%, cancer 0.2%) and 16.2% of HIV-uninfected women (ASCUS 12.7%, LSIL 2.3%, HSIL 1.2%, cancer 0.0%). Risk factors for any abnormal cytology in multivariate analysis included HIV infection, CD4 cell count, HIV RNA level, detection of human papillomavirus (HPV), a prior history of abnormal cytology, employment, and number of male sex partners within 6 months of enrollment. Prior abortion was associated with a decreased risk of cytologic abnormality. Conclusions: Cervical cytologic abnormalities were frequent among women infected with HIV, although high-grade changes were found in only 2.5%. Factors linked to sexual and reproductive history, HPV infection, and HIV disease all influenced risk.

Original languageEnglish (US)
Pages (from-to)33-41
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes and Human Retrovirology
Issue number1
StatePublished - May 1 1999


  • Cytology
  • HIV
  • Screening
  • Squamous intraepithelial lesion

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Virology


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