PAPANICOLAOU SMEARS IN HUMAN IMMUNODEFICIENCY VIRUS-SEROPOSITIVE WOMEN DURING FOLLOW-UP

Objective: To assess the outcome of cervical squamous intraepithelial lesions (SIL) in human immunodeficiency virus (HIV)-seropositive women. Methods: Papanicolaou smears were followed-up prospectively in a group of 60 HIV-positive women every 6 months for 18 months. Results: The cumulative incidence of SIL at 18 months was 9% in 27 women who presented with normal Papanicolaou smears at entry. In 33 women who initially presented with SIL, the rate of persistence of cervical lesions was 95% (18 of 19) in untreated patients and 61% (eight of 13) in women who underwent surgery. In women with low-grade SIL, the persistence or progression of cervical lesions was observed in 92% of the cases (12 of 13). No invasive cancer was observed during the 18 months of the study period. Conclusion: Although the long-term outcome of SIL in this population remains unknown, our results emphasize the high rate of persistence of SIL and the relative inefficiency of conventional treatment in HIV-infected women. These findings contrast with the natural history of SIL in immunocompetent women.