Journal of acquired immune deficiency syndromes (1999) · 2026
Prevalence and Predictors of Abnormal Cervical Cytology Among Women Living With HIV and Without HIV From the MACS/WIHS Combined Cohort Study.
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Guillaume Dominique, Olson Sarah, Dionne Jodie A, Alcaide Maria L, Kassaye Seble, Ramirez Catalina, Wang Chia-Ching J, Cejtin Helen, Ofotokun Igho, Anastos Kathryn, Brockmann Susan, D'Souza Gypsyamber
Аннотация
BACKGROUND: Cervical cancer incidence has markedly declined among US women living with HIV (WLWH) and women without HIV (WWoH). We examined the effects of HIV and immunosuppression on cervical abnormalities in the current antiretroviral treatment era.
METHODS: We conducted a cross-sectional analysis of WLWH and WWoH aged 29-74 years enrolled in the MACS/Women's Interagency Study Combined Cohort Study. For each participant, the first Papanicolaou smear (Pap) performed between October 2020 and March 2024 was included. Wilcoxon rank sum tests and Pearson χ 2 tests compared participant characteristics by HIV serostatus. Multivariable logistic regression models identified sociodemographic, behavioral, and clinical predictors of abnormal cervical cytology [≥ atypical squamous cells of undetermined significance (ASCUS), ≥ low-grade squamous intraepithelial lesion (LSIL)].
RESULTS: A total of 1643 women were included in our analysis. The median age for WLWH was 54 years and 52 years for WWoH. Most had normal cytology (86.5%), ASCUS was seen in 8.0%, LSIL was seen in 4.8%, and high-grade cytology (high-grade squamous epithelial lesion/ASC-H/AGC) was rare (0.7%). Abnormal cytology (≥ASCUS) was higher among WLWH with CD4 < 200 (45.1%) and 200-349 (28.1%) than those with CD4 ≥ 350 (12.7%), ≥500 (13.2%), and WWoH (8.6%). After adjustment, ≥LSIL remained associated with current smoking [aOR = 2.2, (1.4-3.4)], prior CIN2+ [aOR = 9.0, (5.2-15.5)], and lower CD4 counts ( P = trend <0.01; compared with WWoH, WLWH CD4 ≥ 500 aOR = 2.6 [1.4-4.9]; WLWH CD4 < 200 aOR = 8.8, [3.5-22.4]). Predictors for ≥ASCUS were similar to those of ≥LSIL.
CONCLUSION: The prevalence of cervical abnormalities was low in our population. HIV status, lower CD4 counts, prior abnormal cytology, and smoking increased the odds of cervical abnormalities.
METHODS: We conducted a cross-sectional analysis of WLWH and WWoH aged 29-74 years enrolled in the MACS/Women's Interagency Study Combined Cohort Study. For each participant, the first Papanicolaou smear (Pap) performed between October 2020 and March 2024 was included. Wilcoxon rank sum tests and Pearson χ 2 tests compared participant characteristics by HIV serostatus. Multivariable logistic regression models identified sociodemographic, behavioral, and clinical predictors of abnormal cervical cytology [≥ atypical squamous cells of undetermined significance (ASCUS), ≥ low-grade squamous intraepithelial lesion (LSIL)].
RESULTS: A total of 1643 women were included in our analysis. The median age for WLWH was 54 years and 52 years for WWoH. Most had normal cytology (86.5%), ASCUS was seen in 8.0%, LSIL was seen in 4.8%, and high-grade cytology (high-grade squamous epithelial lesion/ASC-H/AGC) was rare (0.7%). Abnormal cytology (≥ASCUS) was higher among WLWH with CD4 < 200 (45.1%) and 200-349 (28.1%) than those with CD4 ≥ 350 (12.7%), ≥500 (13.2%), and WWoH (8.6%). After adjustment, ≥LSIL remained associated with current smoking [aOR = 2.2, (1.4-3.4)], prior CIN2+ [aOR = 9.0, (5.2-15.5)], and lower CD4 counts ( P = trend <0.01; compared with WWoH, WLWH CD4 ≥ 500 aOR = 2.6 [1.4-4.9]; WLWH CD4 < 200 aOR = 8.8, [3.5-22.4]). Predictors for ≥ASCUS were similar to those of ≥LSIL.
CONCLUSION: The prevalence of cervical abnormalities was low in our population. HIV status, lower CD4 counts, prior abnormal cytology, and smoking increased the odds of cervical abnormalities.