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.
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