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Comparison of Conventional Cervical Cytology Versus Visual Inspection With Acetic Acid Among Human Immunodeficiency Virus–Infected Women in Western Kenya

Mabeya, Hillary MBChB, MMED1,2; Khozaim, Kareem MD3; Liu, Tao PhD3; Orango, Omenge MBChB, MMED1,2; Chumba, David MBChB, MMED1,2; Pisharodi, Latha MD3; Carter, Jane MD4; Cu-Uvin, Susan MD4

Journal of Lower Genital Tract Disease: April 2012 - Volume 16 - Issue 2 - p 92–97
doi: 10.1097/LGT.0b013e3182320f0c
Original Articles

Objective This study aimed to determine the accuracy of visual inspection with acetic acid (VIA) versus conventional Pap smear as a screening tool for cervical intraepithelial neoplasia/cancer among human immunodeficiency virus (HIV)–infected women.

Materials and Methods A total of 150 HIV-infected women attending the Moi Teaching and Referral Hospital HIV clinic in Eldoret underwent conventional Pap smear, VIA, colposcopy, and biopsy. Both VIA and Pap smears were done by nurses, whereas colposcopy and biopsy were done by a physician. Receiver operating characteristic analysis was conducted to compare the accuracies between VIA and Pap smear in sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results Among the study part icipants: VIA was abnormal in 55.3% (83/150, 95% confidence interval [CI] = 47.0%–63.5%); Pap smear showed atypical squamous cells of undetermined significance or worse in 43.7% (59/135, 95% CI = 35.2%–52.5%) and 10% (15/150) of the Pap smears were unsatisfactory. Of the abnormal Pap smears, 3% (2/59) had atypical squamous cells of undetermined significance, 7% (4/59) had high-grade atypical squamous cells, 60% (35/59) had low-grade squamous intraepithelial lesions, 29% (17/59) had high-grade squamous intraepithelial lesions, and 2% (1/59) was suspicious for cervical cancer. Using cervical intraepithelial neoplasia 2 or higher disease on biopsy as an end point, VIA has a sensitivity of 69.6% (95% CI = 55.1%–81.0%), specificity of 51.0% (95% CI = 41.5%–60.4%), PPV of 38.6% (95% CI = 28.8%–49.3%), and NPV of 79.1% (95% CI = 67.8%–87.2%). For conventional Pap smear, sensitivity was 52.5% (95% CI = 42.1%–71.5%), specificity was 66.3% (95% CI = 52.0%–71.2%), PPV was 39.7% (95% CI = 27.6%–51.8%), and NPV was 76.8% (95% CI = 67.0%–85.6%).

Conclusions Visual inspection with acetic acid is comparable to Pap smear and acceptable for screening HIV-infected women in resource-limited settings such as Western Kenya.

Visual inspection with acetic acid is comparable to Pap smear and acceptable for screening human immunodeficiency virus–infected women in resource-limited settings such as Western Kenya.

1United States Agency for International Development–Academic Model Providing Access to Healthcare Partnership; 2Moi University School of Medicine, Eldoret, Kenya; 3Indiana University School of Medicine, Indianapolis, IN; and 4Warren Alpert Medical School of Brown University, Providence, RI

Reprint requests to: Kareem Khozaim, MD, 402 N New Jersey St, Apt. G, Indianapolis, IN 46204. E-mail:

This project was supported by the Fogarty International Center/National Institutes of Health (D43TW000237), Brown/Tufts CFAR (P30AI042853), and K24AI066884 (S.C.U.).

This research was supported by AIDS International Training and Research Program. Forgarty AIDS International: Cervical Cancer Screening for HIV-Seropositive Women, Moi University, Eldoret, Kenya (710-9627 cervical cancer screening grant).

This study was presented as a poster at the 17th Conference on Retroviruses and Opportunistic Infections, San Francisco, CA, 2010.

©2012The American Society for Colposcopy and Cervical Pathology