@article{1541,
  keywords = {ASC-H, HIV, HSIL, low-resource community},
  author = {Pam Michelow and Ingrid Hartman and Doreen Schulze and Stella Lamla-Hillie and Sophie Williams and Simon Levin and Cynthia Firnhaber},
  title = {Atypical squamous cells, cannot exclude high grade squamous intraepithelial (ASC-H) in HIV-positive women.},
  abstract = {<p><strong>OBJECTIVE: </strong>South Africa has very high rates of both HIV infection and cervical pathology. The management of ASC-H is colposcopy and directed biopsy, but with so many women diagnosed with HSIL and a dearth of colposcopy centres in South Africa, women with cytologic diagnosis of ASC-H may not be prioritized for colposcopy. The aim of this study was to determine if HIV-positive women with a cytologic diagnosis of ASC-H should undergo immediate colposcopy or whether colposcopy can be delayed, within the context of an underfunded health care setting with so many competing health needs.</p><p><strong>MATERIALS AND METHODS: </strong>A computer database search was performed from the archives of an NGO-administered clinic that offers comprehensive HIV care. All women with a cytologic diagnosis of ASC-H on cervical smears from September 2005 until August 2009 were identified. Histologic follow up was sought in all patients.</p><p><strong>RESULTS: </strong>A total of 2111 cervical smears were performed and 41 diagnosed as ASC-H (1.94\%). No histologic follow up data was available in 15 cases. Follow up histologic results were as follows: three negative (11.5\%), five koilocytosis and/ or CIN1 (19.2\%), ten CIN2 (38.5\%) and eight CIN3 (30.8\%). There were no cases of invasive carcinoma on follow up.</p><p><strong>CONCLUSION: </strong>The current appropriate management of HIV-positive women in low-resource settings with a diagnosis of ASC-H on cervical smear is colposcopy, despite the costs involved. In the future and if cost-effective in developing nations, use of novel markers may help select which HIV-positive women can be managed conservatively and which ones referred for more active treatment. More research in this regard is warranted.</p>},
  year = {2010},
  journal = {CytoJournal},
  volume = {7},
  pages = {8},
  month = {06/2010},
  issn = {1742-6413},
  doi = {10.4103/1742-6413.64376},
  language = {eng},
}