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Longer cervical cancer screening intervals feasible for HIV-positive women with negative co-test results
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Women who are HIV positive but test negative for cervical precancer on both cervical cytologic and HPV DNA tests may be able to extend the time between screenings, according to data published as a researcher’s letter.
Currently, women who have negative cervical cytologic tests and negative HPV DNA testing do not need to undergo additional cervical cancer screening for at least another 3 years. In contrast, women who are HIV positive must undergo screening twice in the first year postdiagnosis and annually thereafter.
In this study, the researchers sought to determine if HIV-positive women could follow the same screening guidelines as HIV-negative women if they are negative on both screening tests.
The researchers looked at all HIV-positive women at Kaiser Permanente who tested negative on co-tests for cervical cancer between 2003 and 2010. The study included 245 women aged 30 years or older.
Median time to the second co-test was 24.4 months.
Of 241 women with Pap test results, 8.7% had positive results; of those with HPV results, 11.3% had positive results.
Among this group of women, the researchers found no cases of histologically confirmed cervical intraepithelial neoplasia 2+, and only one case of high-grade squamous intraepithelial neoplasia. This translates into a 0% risk of CIN2+ and a 0.4% risk for high-grade squamous intraepithelial lesions.
“In this population of HIV-infected women 30 years and older, we found that a negative co-test result conferred excellent safety against cervical precancer and cancer, which is akin to the safety co-testing provides HIV-negative populations,” the researchers wrote. “While more data are needed, these results suggest that it may be acceptable and safe to extend cervical cancer screening intervals by including HPV testing, thereby minimizing the harms of screening.”
Perspective
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Maurie Markman, MD
This is an interesting report and helps to answer a highly relevant question regarding monitoring for cervix cancer in women who are HIV positive. Although the patient numbers in this report are limited, the data suggest HIV-positive individuals can undergo a similar cervix cancer screening program as women without a history of HIV infection. It will be important to determine if other groups with a large HIV-positive female population are able to confirm the results noted in this report.
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