Screening for cervical cancer in HIV-infected women and adolescents
- William R Robinson, MD
William R Robinson, MD
- Professor of Gynecologic Oncology
- Tulane Medical School
Cervical cancer screening is important for all women . The availability of screening tests allows detection of preinvasive disease, cervical intraepithelial neoplasia (CIN). CIN can be treated to prevent progression to invasive cancer. Human papillomavirus (HPV) infection is the etiology of most cervical cancers.
Screening for cervical cancer is of particular importance for women and adolescent girls infected with human immunodeficiency virus (HIV). The incidence of CIN, as confirmed by colposcopy, is four to five times higher in HIV-infected women and adolescents compared to HIV-negative women and adolescents with high-risk sexual behaviors [2-4]. CIN is common in HIV-infected women because [5-9]:
●Both HIV and HPV are sexually transmitted
●HIV-infected women are more likely to have persistent HPV infection
●Persistent infection with one or more oncogenic HPV subtypes is a major factor in the pathogenesis of premalignant and malignant cervical diseaseTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Committee on Practice Bulletins—Gynecology. Practice Bulletin No. 168: Cervical Cancer Screening and Prevention. Obstet Gynecol 2016; 128:e111.
- Wright TC Jr, Ellerbrock TV, Chiasson MA, et al. Cervical intraepithelial neoplasia in women infected with human immunodeficiency virus: prevalence, risk factors, and validity of Papanicolaou smears. New York Cervical Disease Study. Obstet Gynecol 1994; 84:591.
- Ellerbrock TV, Chiasson MA, Bush TJ, et al. Incidence of cervical squamous intraepithelial lesions in HIV-infected women. JAMA 2000; 283:1031.
- Moscicki AB, Ellenberg JH, Crowley-Nowick P, et al. Risk of high-grade squamous intraepithelial lesion in HIV-infected adolescents. J Infect Dis 2004; 190:1413.
- Strickler HD, Burk RD, Fazzari M, et al. Natural history and possible reactivation of human papillomavirus in human immunodeficiency virus-positive women. J Natl Cancer Inst 2005; 97:577.
- Clifford GM, Gonçalves MA, Franceschi S, HPV and HIV Study Group. Human papillomavirus types among women infected with HIV: a meta-analysis. AIDS 2006; 20:2337.
- Frisch M, Biggar RJ, Goedert JJ. Human papillomavirus-associated cancers in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. J Natl Cancer Inst 2000; 92:1500.
- Dal Maso L, Franceschi S, Polesel J, et al. Risk of cancer in persons with AIDS in Italy, 1985-1998. Br J Cancer 2003; 89:94.
- Mbulaiteye SM, Katabira ET, Wabinga H, et al. Spectrum of cancers among HIV-infected persons in Africa: the Uganda AIDS-Cancer Registry Match Study. Int J Cancer 2006; 118:985.
- Oster AM, Sullivan PS, Blair JM. Prevalence of cervical cancer screening of HIV-infected women in the United States. J Acquir Immune Defic Syndr 2009; 51:430.
- Robinson WR, Barnes SE, Adams S, Perrin MS. Histology/cytology discrepancies in HIV-infected obstetric patients with normal pap smears. Gynecol Oncol 1997; 65:430.
- Olaitan A, Mocroft A, McCarthy K, et al. Cervical abnormality and sexually transmitted disease screening in human immunodeficiency virus-positive women. Obstet Gynecol 1997; 89:71.
- Maiman M, Fruchter RG, Sedlis A, et al. Prevalence, risk factors, and accuracy of cytologic screening for cervical intraepithelial neoplasia in women with the human immunodeficiency virus. Gynecol Oncol 1998; 68:233.
- Robinson WR, Luck MB, Kendall MA, Darragh TM. The predictive value of cytologic testing in women with the human immunodeficiency virus who have low-grade squamous cervical lesions: a substudy of a randomized, phase III chemoprevention trial. Am J Obstet Gynecol 2003; 188:896.
- Wright TC Jr, Moscarelli RD, Dole P, et al. Significance of mild cytologic atypia in women infected with human immunodeficiency virus. Obstet Gynecol 1996; 87:515.
- Cohn JA, Gagnon S, Spence MR, et al. The role of human papillomavirus deoxyribonucleic acid assay and repeated cervical cytologic examination in the detection of cervical intraepithelial neoplasia among human immunodeficiency virus-infected women. Cervical Disease Study Group of the American Foundation for AIDS Research Community Based Clinical Trials Network. Am J Obstet Gynecol 2001; 184:322.
- Boardman LA, Peipert JF, Cooper AS, et al. Cytologic-histologic discrepancy in human immunodeficiency virus-positive women referred to a colposcopy clinic. Obstet Gynecol 1994; 84:1016.
- Kitchener H, Nelson L, Adams J, et al. Colposcopy is not necessary to assess the risk to the cervix in HIV-positive women: an international cohort study of cervical pathology in HIV-1 positive women. Int J Cancer 2007; 121:2484.
- Boardman LA, Cotter K, Raker C, Cu-Uvin S. Cervical intraepithelial neoplasia grade 2 or worse in human immunodeficiency virus-infected women with mildly abnormal cervical cytology. Obstet Gynecol 2008; 112:238.
- Swierczynski SL, Lewis-Chambers S, Anderson JR, et al. Impact of liquid-based gynecologic cytology on an HIV-positive population. Acta Cytol 2004; 48:165.
- Harris TG, Burk RD, Palefsky JM, et al. Incidence of cervical squamous intraepithelial lesions associated with HIV serostatus, CD4 cell counts, and human papillomavirus test results. JAMA 2005; 293:1471.
- Massad LS, Evans CT, Strickler HD, et al. Outcome after negative colposcopy among human immunodeficiency virus-infected women with borderline cytologic abnormalities. Obstet Gynecol 2005; 106:525.
- Anderson JR, Paramsothy P, Heilig C, et al. Accuracy of Papanicolaou test among HIV-infected women. Clin Infect Dis 2006; 42:562.
- https://aidsinfo.nih.gov/guidelines (Accessed on January 18, 2016).
- United States Preventive Services Task Force. Guide to Clinical Preventive Services, 2nd, Williams and Wilkins, Baltimore Vol 1996, p.105.
- American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins–Gynecology. Practice Bulletin No. 167: Gynecologic Care for Women and Adolescents With Human Immunodeficiency Virus. Obstet Gynecol 2016; 128:e89.
- Holcomb K, Maiman M, Dimaio T, Gates J. Rapid progression to invasive cervix cancer in a woman infected with the human immunodeficiency virus. Obstet Gynecol 1998; 91:848.
- Massad LS, DʼSouza G, Tian F, et al. Negative predictive value of pap testing: implications for screening intervals for women with human immunodeficiency virus. Obstet Gynecol 2012; 120:791.
- Goldie SJ, Weinstein MC, Kuntz KM, Freedberg KA. The costs, clinical benefits, and cost-effectiveness of screening for cervical cancer in HIV-infected women. Ann Intern Med 1999; 130:97.
- Robinson WR, Freeman D. Improved outcome of cervical neoplasia in HIV-infected women in the era of highly active antiretroviral therapy. AIDS Patient Care STDS 2002; 16:61.
- Robinson WR, Hamilton CA, Michaels SH, Kissinger P. Effect of excisional therapy and highly active antiretroviral therapy on cervical intraepithelial neoplasia in women infected with human immunodeficiency virus. Am J Obstet Gynecol 2001; 184:538.
- Soncini E, Zoncada A, Condemi V, et al. Reduction of the risk of cervical intraepithelial neoplasia in HIV-infected women treated with highly active antiretroviral therapy. Acta Biomed 2007; 78:36.
- Heard I, Palefsky JM, Kazatchkine MD. The impact of HIV antiviral therapy on human papillomavirus (HPV) infections and HPV-related diseases. Antivir Ther 2004; 9:13.
- Ahdieh-Grant L, Li R, Levine AM, et al. Highly active antiretroviral therapy and cervical squamous intraepithelial lesions in human immunodeficiency virus-positive women. J Natl Cancer Inst 2004; 96:1070.
- Biggar RJ, Chaturvedi AK, Goedert JJ, et al. AIDS-related cancer and severity of immunosuppression in persons with AIDS. J Natl Cancer Inst 2007; 99:962.
- Palefsky JM. Human papillomavirus-associated anogenital neoplasia and other solid tumors in human immunodeficiency virus-infected individuals. Curr Opin Oncol 1991; 3:881.
- Abercrombie PD, Korn AP. Lower genital tract neoplasia in women with HIV infection. Oncology (Williston Park) 1998; 12:1735.
- Massad LS, Einstein MH, Huh WK, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol 2013; 121:829.
- www.ASCCP.org (Accessed on December 22, 2010).
- Massad LS, Schneider MF, Watts DH, et al. HPV testing for triage of HIV-infected women with papanicolaou smears read as atypical squamous cells of uncertain significance. J Womens Health (Larchmt) 2004; 13:147.
- Kirby TO, Allen ME, Alvarez RD, et al. High-risk human papillomavirus and cervical intraepithelial neoplasia at time of atypical squamous cells of undetermined significance cytologic results in a population with human immunodeficiency virus. J Low Genit Tract Dis 2004; 8:298.
- Massad LS, Xie X, Darragh TM, et al. Histologic correlates of glandular abnormalities in cervical cytology among women with human immunodeficiency virus. Obstet Gynecol 2009; 114:1063.
- Paramsothy P, Duerr A, Heilig CM, et al. Abnormal vaginal cytology in HIV-infected and at-risk women after hysterectomy. J Acquir Immune Defic Syndr 2004; 35:484.
- Smeltzer S, Yu X, Schmeler K, Levison J. Abnormal Vaginal Pap Test Results After Hysterectomy in Human Immunodeficiency Virus-Infected Women. Obstet Gynecol 2016; 128:52.
- Robinson WR. Long-Term Follow-Up of HIV-Infected Women with Cervical Dysplasia. AIDS Patient Care STDS 2015; 29:517.
- Goldie SJ, Freedberg KA, Weinstein MC, et al. Cost effectiveness of human papillomavirus testing to augment cervical cancer screening in women infected with the human immunodeficiency virus. Am J Med 2001; 111:140.
- McKenzie ND, Kobetz EN, Hnatyszyn J, et al. Women with HIV are more commonly infected with non-16 and -18 high-risk HPV types. Gynecol Oncol 2010; 116:572.
- Heard I, Cubie HA, Mesher D, et al. Characteristics of HPV infection over time in European women who are HIV-1 positive. BJOG 2013; 120:41.
- Rao A, Sandri MT, Sideri M, et al. Comparison of hybrid capture 2 High-Risk HPV results in the low positive range with cobas® HPV Test results from the ATHENA study. J Clin Virol 2013; 58:161.