Cervical Cancer Risk the Same for HIV-Positive and HIV-Negative Women

Findings of a new study suggest women infected with HIV do not need more frequent Pap tests.

The risk of developing cervical cancer is similar in HIV-infected women and women who are not infected with HIV, according to new research published in the July 25, 2012, issue of the Journal of the American Medical Association and presented at a media briefing at the International AIDS Conference in Washington, D.C.

HIV infection, a compromised immune system, in utero exposure to diethylstilbestrol, and previous treatment of a high-grade precancerous lesion or cervical cancer are all factors that put a woman at increased risk for cervical cancer.

Researchers followed more than 400 HIV-infected women and nearly 300 HIV-free women enrolled in the Women's Interagency HIV Study (WIHS), the largest prospective study of HIV-positive women in the United States. All of the women displayed normal cervical cytology at baseline and tested negative for oncogenic human papillomavirus (HPV) DNA at enrollment.

Investigators concluded that there is a similar risk of cervical precancer and cancer in HIV-infected women and HIV-uninfected women with normal cervical cytology and a negative test result for HPV. After 5 years of follow-up, none of the women in the study developed cervical cancer.

In March 2012, the United States Preventive Services Task Force (USPSTF) revised its cervical cancer screening guidelines for HIV-negative women 30 years or older from once every 3 years to once every 5 years, provided that they have a normal Pap smear test and a negative test for HPV, certain strains of which are associated with cervical cancer.

Current recommendations for HIV-positive women were not addressed by the USPSTF changes. It is recommended that HIV-positive women have 2 Pap tests, at 6-month intervals, in the first year following diagnosis of HIV and, if normal, on an annual basis.

"Overall, few cases of cervical precancer would have gone undiagnosed if the HIV-positive women did not have any additional Pap tests during the 5 years following enrollment—no more than in the HIV-negative group," said lead author Marla Keller, MD, associate professor of medicine and of obstetrics and gynecology and women's health at Albert Einstein College of Medicine,Yeshiva University, in a press release. "Thus, these data raise the possibility that HPV and Pap cotesting could be used to reduce the burden of frequent Pap tests and, by extension, unnecessary biopsies in HIV-positive women who are in long-term clinical follow-up."

Watch the below video featuring Marla Keller, MD, for an explanation about HPV and the risk of cervical cancer in HIV-infected women: