Abnormal cytology in HIV-positive women referred for colposcopy: an analysis of cytology-colposcopy-histology correlation
AbstractContext: HIV/AIDS is thought to facilitate the development of cervical neoplasia. Concern has been expressed about the efficiency of standard screening and treatment procedures in HIV/AIDS patients
Objective: The objective of the study was to examine the performance of standard modalities of cervical cancer screening and management in Human Immunodeficiency Virus (HIV) positive women.
Method: A retrospective review of case records of HIV positive women referred to the colposcopy clinic of a tertiary referral centre in Cape Town, South Africa was done to correlate the cytologic referral findings with colposcopic evaluation and histological diagnosis of biopsy samples. Findings at subsequent follow-up examinations were also evaluated to assess efficacy of treatment or disease progression.
Result: A total of 77 patients, aged 20 to 55 with a mean age of 30.34 [SD: 6.86] years, constituted the study group. There was agreement between cytological and colposcopic findings in 53% and 69% of low-grade (LG) and highgrade (HG) squamous intraepithelial lesions (SIL) respectively. Only in 6% of patients did colposcopy find a highergrade lesion than cytology. Histological samples were available for 58 of the 77 patients and the agreement between cytology and histology for HGSIL and LGSIL were 63.9% and 76.2% respectively. On follow-up for 3-24 (median: 8)months, 18% of LGSIL progressed to HGSIL, 63.6% remained stable and 18.2% regressed. Nearly 70% of patients with HGSIL remained lesion-free, 23% showed persistent disease and one patient progressed to invasive carcinoma during follow-up.
Conclusion: Standard modes of conservative management provide satisfactory results in the management of HIV seropositive women with abnormal Pap smears.
Keywords: HIV, cytology, colposcopy, cervical biopsy
Tropical Journal of Obstetrics and Gynaecology Vol. 22(2) 2005: 129-132
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