title: Risk of cervical precancer and cancer among HIV-infected women with normal cervical cytology and no evidence of oncogenic HPV infection.
abstract: BACKGROUND
  US 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 (Pap test) 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.
  
  
  OBJECTIVE
  To determine the risk of cervical precancer or cancer defined cytologically (high-grade squamous intraepithelial lesions or greater [HSIL+]) or histologically (cervical intraepithelial neoplasia 2 or greater [CIN-2+]), as 2 separate end points, in HIV-infected women and HIV-uninfected women who at baseline had a normal Pap test result and were negative for oncogenic HPV.
  
  
  METHODS
  Participants included 420 HIV-infected women and 279 HIV-uninfected women with normal cervical cytology at their enrollment in a multi-institutional US cohort of the Women's Interagency HIV Study, between October 1, 2001, and September 30, 2002, with follow-up through April 30, 2011. Semiannual visits at 6 clinical sites included Pap testing and, if indicated, cervical biopsy. Cervicovaginal lavage specimens from enrollment were tested for HPV DNA using polymerase chain reaction. The primary analysis was truncated at 5 years of follow-up.
  
  
  METHODS
  Five-year cumulative incidence of cervical precancer and cancer.
  
  
  RESULTS
  No oncogenic HPV was detected in 369 (88% [95% CI, 84%-91%]) HIV-infected women and 255 (91% [95% CI, 88%-94%]) HIV-uninfected women with normal cervical cytology at enrollment. Among these oncogenic HPV-negative women, 2 cases of HSIL+ were observed; an HIV-uninfected woman and an HIV-infected woman with a CD4 cell count of 500 cells/μL or greater. Histologic data were obtained from 4 of the 6 clinical sites. There were 6 cases of CIN-2+ in 145 HIV-uninfected women (cumulative incidence, 5% [95% CI, 1%-8%]) and 9 cases in 219 HIV-infected women (cumulative incidence, 5% [95% CI, 2%-8%]). This included 1 case of CIN-2+ in 44 oncogenic HPV-negative HIV-infected women with CD4 cell count less than 350 cells/μL (cumulative incidence, 2% [95% CI, 0%-7%]), 1 case in 47 women with CD4 cell count of 350 to 499 cells/μL (cumulative incidence, 2% [95% CI, 0%-7%]), and 7 cases in 128 women with CD4 cell count of 500 cells/μL or greater (cumulative incidence, 6% [95% CI, 2%-10%]). One HIV-infected and 1 HIV-uninfected woman had CIN-3, but none had cancer.
  
  
  CONCLUSIONS
  The 5-year cumulative incidence of HSIL+ and CIN-2+ was similar in HIV-infected women and HIV-uninfected women who were cytologically normal and oncogenic HPV-negative at enrollment.
authors: Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Mazer Bldg, Room 512, Bronx, NY 10461, USA. marla.keller@einstein.yu.edu
authors: Marla J
authors: MJ
authors: Keller
authors: Robert D
authors: RD
authors: Burk
authors: Xianhong
authors: X
authors: Xie
authors: Kathryn
authors: K
authors: Anastos
authors: L Stewart
authors: LS
authors: Massad
authors: Howard
authors: H
authors: Minkoff
authors: Xiaonan
authors: X
authors: Xue
authors: Gypsyamber
authors: G
authors: D'Souza
authors: D Heather
authors: DH
authors: Watts
authors: Alexandra M
authors: AM
authors: Levine
authors: Philip E
authors: PE
authors: Castle
authors: Christine
authors: C
authors: Colie
authors: Joel M
authors: JM
authors: Palefsky
authors: Howard D
authors: HD
authors: Strickler
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002584:Cervix Uteri / Q000166:cytology; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D015658:HIV Infections; D006801:Humans; D015994:Incidence; D065006:Papanicolaou Test; D030361:Papillomavirus Infections; D011230:Precancerous Conditions / Q000453:epidemiology*; D012306:Risk; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology*