Screening for Human Papillomavirus-Associated Cervical Disease in HIV-Infected Women

Abstract

HIV-infected women have higher rates of persistence of human papillomavirus (HPV) infection, of abnormal cervical cytology results, and of cervical cancer than uninfected women. It is currently recommended that HIV-infected, sexually active women have a Papanicolaou (Pap) test performed at the time of initial diagnosis of HIV infection, followed by annual Pap testing if the previous test result is normal. Women whose test results show abnormalities greater than atypical squamous cells of undetermined significance (ASCUS) should be referred for colposcopy. Those with ASCUS should undergo immediate colposcopy or repeat cervical cytology in 6 months to 12 months, and those whose repeat cervical cytology results show ASCUS or greater abnormalities should undergo colposcopy. Recent findings indicate that screening intervals can be lengthened for HIV-infected women whose Pap test results are persistently normal and who are engaged in routine care, and that HPV DNA testing may have a role in screening. This article summarizes a presentation by Marla J. Keller, MD, at the IAS-USA continuing education program, Improving the Management of HIV Disease, held in Atlanta, Georgia, in March 2015.

Figure.

Risk for invasive cervical cancer according to CD4+ cell count in HIV-infected women. Adapted from Abraham et al.