Histology/cytology discrepancies in HIV-infected obstetric patients with normal pap smears.

OBJECTIVE

To estimate the frequency of cervical cytologic/histologic discrepancies in a group of obstetric patients diagnosed as HIV infected by routine prenatal screening. Also, to determine if serum CD4 levels or sexually transmitted diseases (STDs) are associated with the occurrence of preinvasive cervical disease in these women.

METHOD

Thirty-two women who presented for routine prenatal care to Medical Center of Louisiana were diagnosed as HIV infected by ELISA and Western blot testing and had normal Pap smears. These patients then agreed to undergo the following: colposcopy with directed biopsies; chlamydia, gonorrhea, and syphilis screening; and serum CD4 level.

RESULTS

No patients had AIDS-defining diagnoses other than CD4 < 200/mm3. Ten of 32 (31%) had cervical intraepithelial neoplasia (CIN) despite normal cytology. Six of 32 (19%) had STDs. One of 10 in the group with CIN had a STD. The mean CD4 level in those patients with CIN was 249/mm2 (range 1-524) vs 501/mm2 (range 210-979) in those without CIN. (P = 0.0118)

CONCLUSIONS

Newly diagnosed HIV-infected pregnant women without clinical evidence of AIDS are noted to have CIN at a rate similar to nonpregnant HIV-infected women. The Pap smear appears to have a significant false-negative rate in this group. STDs, while common, were not directly associated with false-negative Pap smears. CIN is associated with immunosuppression, as measured by low CD4 counts.