title: Human Papillomavirus Co-Testing Results Effectively Triage Normal Cervical Cytology in HIV-Positive Women Aged 30 Years and Older.
abstract: OBJECTIVE
  The aim of the study was to assess whether HIV-positive (HIV+) women aged 30 years and older with concurrent normal cervical cytology and undetectable cervical HPV have a low 3-year risk of developing cervical intraepithelial neoplasia grade 2 or higher (CIN 2+) in a clinical setting.
  
  
  METHODS
  We conducted a retrospective chart review of HIV+ women aged 30 years and older at a single institution with normal cervical cytology and concurrent human papillomavirus (HPV) testing between November 2008 and December 2010. The participants were stratified by initial HPV testing results and followed to either the study end point (CIN 2+) or until the last cervical cytology or colposcopy before January 2015. Kaplan-Meier survival curves were used to analyze CIN 2+ diagnosis for follow-up with log-rank testing of the null hypothesis. Cox proportional hazard regression was performed to calculate crude and adjusted hazard ratios controlling for ethnicity and CD4 levels.
  
  
  RESULTS
  We identified 325 HIV+ women with normal cytology and follow-up; 66 (20%) of these women had detectable HPV. The cumulative diagnosis of CIN 2+ at 4 years was significantly lower in the HPV-negative cohort compared with the HPV-positive cohort (1.4%, 95% CI = 0.3%-4.6% vs 14.5%, 95% CI = 5.8%-27.1%), respectively; the median duration to CIN 2+ diagnosis was longer in the HPV-negative cohort compared with the HPV-positive cohort (4.2 years vs 1.5 years, respectively, p < .02).
  
  
  CONCLUSIONS
  HIV+ women aged 30 years and older with concurrent normal cervical cytology and undetectable cervical HPV have a low 3-year risk of subsequent diagnosis of CIN 2+. The study validates the recently updated US recommendations for the use of co-testing in screening HIV+ women.
authors.affiliation: 1Quinnipiac University Frank H. Netter School of Medicine, North Haven, CT; 2Boston University Medical Center, Boston, MA; 3Boston University School of Public Health, Boston, MA; and 4Boston University School of Medicine, Boston, MA.
authors.forename: Rachel O
authors.initials: RO
authors.lastname: Alade
authors.forename: Olivera
authors.initials: O
authors.lastname: Vragovic
authors.forename: Conor
authors.initials: C
authors.lastname: Duffy
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Cabral
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology*