New cervical cancer screening guidelines recommend
less frequent assessment
Janelle Yates (June 2012)
HIV-infected women who have normal cervical cytology and who test negative for oncogenic types of human papillomavirus (HPV) have a 5-year risk of cervical precancer and cancer that is equivalent to the risk among women without HIV infection, according to a cohort study published in July in JAMA.1
Howard D. Strickler, MD, MPH, of Albert Einstein College of Medicine of Yeshiva University, New York, and colleagues conducted the study to explore the 3- and 5-year risk of cervical precancer and cancer in 420 HIV-infected women and 279 women without HIV infection. Precancer and cancer were defined on the basis of cytology or histology:
- cytology: a high-grade squamous intraepithelial lesion (HSIL) or more severe finding
- histology: cervical intraepithelial neoplasia (CIN) grade 2 or higher.
Participants in the study underwent semiannual visits, including Pap testing and cervical biopsy, if indicated.
Two cases of HSIL or more severe cytology were observed during the 5 years of follow-up—one among HIV-infected women who had a CD4 cell count of at least 500 cells/μL and one among HIV-negative women. Overall, the cumulative incidence of HSIL or more severe cytology was 0.3% among HIV-infected women and 0.4% among HIV-negative women.
Based on a total of 15 cases, investigators determined that the cumulative incidence of CIN 2+ histology over 5 years was:
- 2% among HIV-infected women who had a CD4 cell count below 350 cells/μL
- 2% among HIV-infected women who had a CD4 cell count of 350 to 499 cells/μL
- 6% among HIV-infected women who had a CD4 cell count of 500 cells/μL or higher
- 5% in women without HIV infection.
When researchers combined the data among HIV-infected women, they found an overall 5-year cumulative incidence of CIN 2+ of 5%.
Screening intervals may one day be extended for HIV-infected women
These findings are important because cervical cancer screening guidelines for women who are not infected with HIV were recently updated to increase the co-testing interval from 3 to 5 years among women who have normal cytology and who test negative for oncogenic HPV. “Whether a 3-year or 5-year screening interval could be used in HIV-infected women who are cytologically normal and oncogenic HPV-negative is unknown,” wrote Strickler and colleagues as background to their study.
“The results of this prospective study suggest that HIV-infected women undergoing long-term clinical follow-up who are cytologically normal and oncogenic HPV-negative have a risk of cervical precancer similar to that in HIV-uninfected women through 5 years of follow-up. Additional observational studies or a randomized clinical trial may be necessary before clinical guideline committees consider whether to expand current recommendations regarding HPV co-testing to HIV-infected women. More broadly, the current investigation highlights the potential for a new era of molecular testing, including HPV as well as other biomarkers, to improve cervical cancer screening in HIV-infected women,” the investigators concluded.
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