Diagnosis
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The guidelines for the interpretation and management of cervical cytopathology may not apply to immunosuppressed women. HIV-positive women have a higher prevalence of cervical dysplasia, higher disease stage at presentation, poorer treatment response, higher recurrence rate, more rapid disease progression, and shorter survival time than seronegative women. HIV-positive women die of cervical cancer before they die of AIDS. For these reasons many experts recommend a lower threshold for colposcopy in HIV-positive
women. (Vaginal, vulvar, and perianal lesions, which often coexist in
such patients, are best identified by colposcopy.) No guidelines for screening
or for managing lesions have been established (Appleby,
Hankins).
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