title: Cervical Precancer Risk in HIV-Infected Women Who Test Positive for Oncogenic Human Papillomavirus Despite a Normal Pap Test.
abstract: BACKGROUND
  Determining cervical precancer risk among human immunodeficiency virus (HIV)-infected women who despite a normal Pap test are positive for oncogenic human papillomavirus (oncHPV) types is important for setting screening practices.
  
  
  METHODS
  A total of 2791 HIV-infected and 975 HIV-uninfected women in the Women's Interagency HIV Study were followed semiannually with Pap tests and colposcopy. Cumulative risks of cervical intraepithelial neoplasia grade 2 or greater (CIN-2+; threshold used for CIN treatment) and grade 3 or greater (CIN-3+; threshold to set screening practices) were measured in HIV-infected and HIV-uninfected women with normal Pap tests, stratified by baseline HPV results, and also in HIV-infected women with a low-grade squamous intraepithelial lesion (LSIL; benchmark indication for colposcopy).
  
  
  RESULTS
  At baseline, 1021 HIV-infected and 518 HIV-uninfected women had normal Pap tests, of whom 154 (15%) and 27 (5%), respectively, tested oncHPV positive. The 5-year CIN-2+ cumulative risk in the HIV-infected oncHPV-positive women was 22% (95% confidence interval [CI], 9%-34%), 12% (95% CI, 0%-22%), and 14% (95% CI, 2%-25%) among those with CD4 counts <350, 350-499, and ≥500 cells/µL, respectively, whereas it was 10% (95% CI, 0%-21%) in those without HIV. For CIN-3+, the cumulative risk averaged 4% (95% CI, 1%-8%) in HIV-infected oncHPV-positive women, and 10% (95% CI, 0%-23%) among those positive for HPV type 16. In HIV-infected women with LSIL, CIN-3+ risk was 7% (95% CI, 3%-11%). In multivariate analysis, HIV-infected HPV16-positive women had 13-fold (P = .001) greater CIN-3+ risk than oncHPV-negative women (referent), and HIV-infected women with LSIL had 9-fold (P < .0001) greater risk.
  
  
  CONCLUSIONS
  HIV-infected women with a normal Pap result who test HPV16 positive have high precancer risk (similar to those with LSIL), possibly warranting immediate colposcopy. Repeat screening in 1 year may be appropriate if non-16 oncHPV is detected.
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Marla J
authors.initials: MJ
authors.lastname: Keller
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Burk
authors.affiliation: Washington University School of Medicine, St Louis, Missouri.
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Isam-Eldin
authors.initials: IE
authors.lastname: Eltoum
authors.affiliation: University of California, San Francisco.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Hessol
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Castle
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anastos
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Xianhong
authors.initials: X
authors.lastname: Xie
authors.affiliation: Maimonides Medical Center, Brooklyn, New York.
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Xiaonan
authors.initials: X
authors.lastname: Xue
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Gypsyamber
authors.initials: G
authors.lastname: D'Souza
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Flowers
authors.affiliation: City of Hope National Medical Center, Duarte, California.
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Levine
authors.affiliation: Georgetown University Medical Center, Washington D.C.
authors.forename: Christine
authors.initials: C
authors.lastname: Colie
authors.affiliation: University of North Carolina School of Medicine, Chapel Hill.
authors.forename: Lisa
authors.initials: L
authors.lastname: Rahangdale
authors.affiliation: University of Miami Miller School of Medicine, Florida.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Fischl
authors.affiliation: University of California, San Francisco.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Palefsky
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Howard D
authors.initials: HD
authors.lastname: Strickler
mesh_terms: D000328:Adult; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications*; D052162:Human papillomavirus 16 / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D011230:Precancerous Conditions / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D011446:Prospective Studies; D018570:Risk Assessment; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000473:pathology / Q000821:virology
keywords: HIV; Pap test; cervical cancer screening; human papillomavirus