Outcome After Negative Colposcopy Among Human Immunodeficiency Virus–Infected Women With Borderline Cytologic Abnormalities
| Autor: | Robert D. Burk, Yi Chun Lee, Lorraine Cashin, D. Heather Watts, Charlesnika T. Evans, Alexandra M. Levine, L. Stewart Massad, Teresa M. Darragh, Howard D. Strickler, Michael Moxley, Stephen J. Gange, Douglas J. Passaro |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
medicine.medical_specialty Uterine Cervical Neoplasms Risk Factors Cytology HIV Seropositivity Humans Multicenter Studies as Topic Medicine Prospective Studies Risk factor Prospective cohort study Colposcopy Cervical cancer Gynecology medicine.diagnostic_test business.industry Obstetrics Hazard ratio Absolute risk reduction Obstetrics and Gynecology Uterine Cervical Dysplasia medicine.disease Squamous intraepithelial lesion Multivariate Analysis Disease Progression Female business |
| Zdroj: | Obstetrics & Gynecology. 106:525-532 |
| ISSN: | 0029-7844 |
| Popis: | 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. LEVEL OF EVIDENCE II-2. |
| Databáze: | OpenAIRE |
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