New data: HIV-infected women do not have an elevated risk of cervical cancer

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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