WASHINGTON, D.C. – HIV-infected and uninfected women with normal cervical cytology (Pap test) and a negative test result for oncogenic (tumor inducing) human papillomavirus DNA at study enrollment had a similar risk of cervical precancer and cancer after 5 years of follow-up, according to a study in the July 25 issue of JAMA, a theme issue on HIV/AIDS.
Howard D. Strickler, M.D., M.P.H., of the Albert Einstein College of Medicine of Yeshiva University, New York, presented the findings of the study at a JAMA media briefing at the International AIDS Conference.
"U.S. cervical cancer screening guidelines for human immunodeficiency virus (HIV)-uninfected women 30 years or older have recently been revised, increasing the suggested interval between Papanicolaou (Pap) tests from 3 years to 5 years among those with normal cervical cytology results who test negative for oncogenic human papillomavirus (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," according to background information in the article.
Dr. Strickler and colleagues conducted a study to examine the 3-year and 5-year risk of cervical precancer and cancer defined by cytology (i.e., high-grade squamous intraepithelial lesion or greater [HSIL+]) and histology (cervical intraepithelial neoplasia 2 or greater [CIN-2+]), in HIV-infected women (n = 420) and HIV-uninfected women (n = 279). The participants, who at the beginning of the study had a normal Pap test result and were negative for oncogenic HPV, were enrolled in a multi-institutional U.S. cohort of the Women's Interagency HIV Study, between October 2001 and September 2002, with follow-up through April 2011. Semiannual visits at 6 clinical sites included Pap testing and, if indicated, cervical biopsy.
Overall, no oncogenic HPV was detected in 369 (88 percent) of the HIV-infected women and 255 (91 percent) of the HIV-uninfected women with normal cervical cytology at enrollment. Two cases of HSIL+ were observed during the 5 years of observation, 1 among the HIV-uninfected women and 1 among the HIV-infected women with a CD4 cell count of 500 cells/µL or greater. Overall, the cumulative incidence of HSIL+ was 0.3 percent in HIV-infected women and 0.4 percent in HIV-uninfected women.
Based on a total of 15 cases, the authors found that the cumulative incidence of CIN-2+ over 5 years of follow-up was 2 percent in HIV-infected women with CD4 cell count less than 350 cells/µL, 2 percent in those with CD4 cell count of 350 to 499 cells/µL, 6 percent in those women with CD4 cell count of 500 cells/µL or greater, and 5 percent in HIV-uninfected women.
When the researchers combined the data among HIV-infected women, they found that the overall 5-year cumulative incidence of CIN-2+ in HIV-infected women was 5 percent. "Of the CIN-2+ cases, 2 were CIN-3 (an HIV-infected woman with a baseline CD4 cell count of 350-499 cells/µL, and an HIV-uninfected woman). The overall 5-year cumulative incidence of CIN-3+ was 0.5 percent in HIV-infected women and 0.7 percent in HIV-uninfected women. No cancers were observed."
"In summary, 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 authors conclude.
(JAMA. 2012;308:362-369. Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
To contact Howard D. Strickler, M.D., M.P.H., call Deirdre Branley at 347-266-9204 or email firstname.lastname@example.org.
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