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Clin Infect Dis. 2015 Nov 15;61(10):1573-81. doi: 10.1093/cid/civ569. Epub 2015 Jul 17.

Cervical Precancer Risk in HIV-Infected Women Who Test Positive for Oncogenic Human Papillomavirus Despite a Normal Pap Test.

Author information

1
Albert Einstein College of Medicine, Bronx, New York.
2
Washington University School of Medicine, St Louis, Missouri.
3
University of Alabama at Birmingham.
4
University of California, San Francisco.
5
Maimonides Medical Center, Brooklyn, New York.
6
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
7
Emory University School of Medicine, Atlanta, Georgia.
8
City of Hope National Medical Center, Duarte, California.
9
Georgetown University Medical Center, Washington D.C.
10
University of North Carolina School of Medicine, Chapel Hill.
11
University of Miami Miller School of Medicine, Florida.

Abstract

BACKGROUND:

Determining cervical precancer risk among human immunodeficiency virus (HIV)-infected women who despite a normal Pap test are positive for oncogenic human papillomavirus (oncHPV) types is important for setting screening practices.

METHODS:

A total of 2791 HIV-infected and 975 HIV-uninfected women in the Women's Interagency HIV Study were followed semiannually with Pap tests and colposcopy. Cumulative risks of cervical intraepithelial neoplasia grade 2 or greater (CIN-2+; threshold used for CIN treatment) and grade 3 or greater (CIN-3+; threshold to set screening practices) were measured in HIV-infected and HIV-uninfected women with normal Pap tests, stratified by baseline HPV results, and also in HIV-infected women with a low-grade squamous intraepithelial lesion (LSIL; benchmark indication for colposcopy).

RESULTS:

At baseline, 1021 HIV-infected and 518 HIV-uninfected women had normal Pap tests, of whom 154 (15%) and 27 (5%), respectively, tested oncHPV positive. The 5-year CIN-2+ cumulative risk in the HIV-infected oncHPV-positive women was 22% (95% confidence interval [CI], 9%-34%), 12% (95% CI, 0%-22%), and 14% (95% CI, 2%-25%) among those with CD4 counts <350, 350-499, and ≥500 cells/µL, respectively, whereas it was 10% (95% CI, 0%-21%) in those without HIV. For CIN-3+, the cumulative risk averaged 4% (95% CI, 1%-8%) in HIV-infected oncHPV-positive women, and 10% (95% CI, 0%-23%) among those positive for HPV type 16. In HIV-infected women with LSIL, CIN-3+ risk was 7% (95% CI, 3%-11%). In multivariate analysis, HIV-infected HPV16-positive women had 13-fold (P = .001) greater CIN-3+ risk than oncHPV-negative women (referent), and HIV-infected women with LSIL had 9-fold (P < .0001) greater risk.

CONCLUSIONS:

HIV-infected women with a normal Pap result who test HPV16 positive have high precancer risk (similar to those with LSIL), possibly warranting immediate colposcopy. Repeat screening in 1 year may be appropriate if non-16 oncHPV is detected.

KEYWORDS:

HIV; Pap test; cervical cancer screening; human papillomavirus

PMID:
26187020
PMCID:
PMC4614409
DOI:
10.1093/cid/civ569
[Indexed for MEDLINE]
Free PMC Article

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