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For women with HIV and abnormal Pap smears, colposcopy should continue to be the next step to rule out cervical cancer

Essentially all cervical cancer, especially high-risk types, arises from precursors associated with infection by human papillomavirus (HPV). Women infected with the human immunodeficiency virus (HIV) are at increased risk for the development of cervical cancer precursors. Since published reports show that women with HIV, whose Pap smears show atypical squamous cells of uncertain significance (ASCUS), have a 14-15 percent risk for high-grade cervical cancer precursors, colposcopy has been recommended for all HIV-infected women with ASCUS on Pap smears. Although colposcopy is costly and uncomfortable, it should remain the next diagnostic step for these women, according to the findings of a recent study.

The researchers found that a simple DNA test for high-risk HPV DNA may not be sensitive enough for clinical use in women with HIV and ASCUS on Pap smears. Lead author, L. Stewart Massad, M.D., of Southern Illinois School of Medicine, and his colleagues compared the results of HPV DNA assays obtained by cervicovaginal lavage (CVL) with colposcopic biopsy findings among women with ASCUS Pap smears, who participated in the Women's Interagency HIV Study (WIHS). WIHS is a multicenter study of the natural history of HIV in women, which is jointly funded by the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Centers for Disease Control and Prevention.

The results indicate that RNA testing of CVL fluid for high-risk HPV DNA by polymerase chain reaction was not sufficiently sensitive. High-risk HPV DNA was found in 30 percent of the 270 women studied. However, the sensitivity of high-risk HPV DNA for detection of advanced precancerous changes (cervical intraepithelial neoplasia) was only 50 percent (it would detect these changes in only half of women who had them), and the specificity was only 71 percent (it would identify only 71 percent of women who truly did not have such changes).

See "HPV testing for triage of HIV-infected women with Papanicolaou smears read as atypical squamous cells of uncertain significance," by Dr. Massad, Michael F. Schneider, M.S., D. Heather Watts, M.D., and others, in the Journal of Women's Health 13(2), pp. 147-153, 2004.

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