Women with human immunodeficiency virus (HIV) who have normal Papanicolaou (Pap) test results and who test negative for oncogenic human papillomavirus (HPV) were not shown to have a greater risk of cervical cancer than HIV-negative women through 5 years of follow-up in a recent study.
In March 2012, the United States Preventive Services Task Force revised its guidelines for cervical cancer screening in HIV-negative women aged 30 years and older, increasing the suggested interval between Pap tests from 3 years to 5 years if the woman has normal cervical cytology (Pap test) results and is oncogenic-HPV-negative. Whether a 3-year or 5-year screening interval could be applied to HIV-positive women who are cytologically normal and oncogenic-HPV-negative is unknown, but the question was explored in a study of 420 women with HIV and 279 without.
The women were studied to determine the risk of cervical precancer or cancer defined cytologically (high-grade squamous intraepithelial lesions or greater [HSIL+]) or histologically (cervical intraepithelial neoplasia 2 or greater [CIN-2+]). All participants had normal cervical cytology upon study enrollment, which took place from October 2001 through September 2002, with follow-up through April 2011. During that time the women underwent semiannual Pap testing and, if indicated, cervical biopsy.
At the 5-year mark, the cumulative incidence of HSIL+ and CIN-2+ was similar between the HIV-positive and HIV-negative women. No oncogenic HPV was detected in 369 (88%) of the HIV-infected patients or in 255 (91%) of the HIV-negative patients.
Data from four of the six clinical sites involved in the study revealed the 5-year cumulative incidence of HSIL+ to be 0.3% for the HIV-positive women and 0.4% for the HIV-negative group. Nine cases of CIN-2+ in 219 HIV-positive women and six cases in 145 HIV-negative women translated to a cumulative incidence of 5% in each group (JAMA. 2012;308:362-369).