The availability of cervical cytology to screen for cervical cancer often permits diagnosis at the preinvasive stage, when treatment can almost always prevent progression to invasive cancer. For this reason, screening for cervical cancer is important in all women. Screening for cervical cancer is of particular concern to HIV infected women and adolescents since the incidence of cervical intraepithelial neoplasia (CIN), as confirmed by colposcopy, is four to five times higher HIV-positive women and adolescents compared to HIV-negative women and adolescents with high risk sexual behaviors [1-3].
CIN is common in HIV infected women because [4-8]:
- Both HIV and human papilloma virus (HPV) are sexually transmitted, and
- HIV infected women are more likely to have persistent HPV infection, and
- Persistent infection with one or more oncogenic HPV subtypes is a major factor in the pathogenesis of premalignant and malignant cervical disease
A study has reported that, unfortunately, as many as one-fourth of HIV-infected women do not get an annual pap smear, despite seeing a primary care provider during that time period, underscoring the need for continued emphasis on cervical cancer screening in this population .
Specific issues regarding screening for cervical cancer in HIV-infected women will be reviewed here. Evaluation and management of women with abnormal screening results and general issues regarding screening for cervical cancer are discussed separately. (See "Preinvasive and invasive cervical neoplasia in HIV-infected women" and "Cervical cancer screening tests: Techniques for cervical cytology and human papillomavirus testing".)