Screening HIV-positive women for cervical intraepithelial neoplasia:: Does it help to know the HPV status and CD4-cell count?

Objective: Cervical intraepithelial neoplasia (CIN) is common in women with HIV infection. We studied whether the detection rate for CIN in this population can be improved by testing for oncogenic human papillomavirus (HPV) subtypes and measuring the CD4-cell count. Methods: 131 HIV-positive women underwent cervical cytology, colposcopy, histology, HPV subtyping, and measurement of the CD4 cell count, Results: CIN was found in 41 (31%) women and infection with oncogenic HPV subtypes in 71 (54%). CIN was more frequent in HPV-positive than in HPV-negative patients (80% vs. 42%) and in women with a CD4=cell count < 200/mm(3) than in those with a higher CD4 count (43% vs. 25%). The 30 women with both HPV infection and a low CD4 count had the highest rate of CIN (56% vs. 11%). The sensitivity and specificity of HPV infection for detecting CIN was 78% and 58% and those of a low CD4-cell count were and 58% and 72%, respectively. Conclusion: Screening HIV-positive women for CIN is not improved by HPV subtyping or CD4-cell counts.