MEDICATIONS: THREE-YEAR CERVICAL CANCER SCREENING RECOMMENDATIONS MAY BE APPLICABLE FOR CERTAIN WOMEN WITH HIV

March 22, 2005 — Women with human immunodeficiency virus (HIV) who have normal cervical cancer screening results and negative tests for human papilloma virus (HPV), a sexually transmitted virus that is associated with cervical cancer, may be able to have Papanicolaou (Pap) smears every three years, the same interval as HIV-negative women, according to a study in the March 23/30 issue of the Journal of the American Medical Association.

According to background information in the article, "cervical cancer screening recommendations in the United States have been recently updated and now advise using an interval of three years between screenings in healthy women 30 years or older who have normal cytology (cells) results and who test negative for oncogenic (cancer-associated) human papilloma virus (HPV) DNA. The recommended interval is six to 12 months for women with normal cytology and detectable oncogenic HPV." Women who are HIV-positive are recommended to have two Pap smears six-months apart after their initial HIV diagnosis, and if both are normal, should undergo an annual screening. HPV test results are not considered.

Tiffany G. Harris, Ph.D., from Albert Einstein College of Medicine, Bronx, N.Y., and colleagues studied the incidence of cervical squamous intraepithelial lesions (SILs) [abnormal lesions] among HIV-seropositive (n= 855) and HIV-seronegative (n= 343) who were enrolled in the Women's Interagency HIV Study (WIHS) and had normal cervical cytology at the beginning of the study. The researchers sought to determine if a single initial HPV test result could be used to determine the appropriate cervical cancer screening interval in an HIV-seropositive woman with normal cervical cytology.

The researchers found that after two years, "there were no large or significant absolute differences in the cumulative incidence of SIL" between the two groups of women. "In this observational cohort study, HIV-seronegative and HIV-seropositive women who had normal cytology results with CD4 (cell) counts greater than 500/microlitre and who had negative test results for HPV at baseline had a similar low cumulative incidence of any SIL for three years or more," the researchers report.

In conclusion the authors write: "Consideration will also need to be given to the psychosocial costs of a positive HPV test in HIV-seropositive women, many of whom will not develop SIL. However, according to the results of our study, we believe that the use of HPV testing in HIV-seropositive women warrants evaluation in a formal clinical trial."