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Many HIV Positive Women Do Not Receive Recommended Regular Pap Smears for Cervical Cancer

Although they are at higher risk for cervical cancer, nearly 25% of HIV positive women did not received recommended annual Pap screening, which allows impending cancer to be detected and treated at an early stage, according to a study in the August 1, 2009 Journal of Acquired Immune Deficiency Syndromes.

Research has consistently shown that people with HIV/AIDS have an elevated risk for many types of cancer, especially those caused by an infectious pathogen such as human papillomavirus (HPV), which can cause cervical, anal, genital, and oral malignancies.

Current HIV treatment guidelines recommend that HIV positive women should received annual Papanicolaou (Pap) tests to detect precancerous cell changes or early stages of cancer (dysplasia or neoplasia). Annual tests used to be recommended for HIV negative women as well, but women with repeated normal tests and no risk factors are now advised to get a Pap smear every 2-3 years.

Alexandra Osterfrom the U.S. Centers for Disease Control and Prevention (CDC) and colleagues assessed screening prevalence and associated factors among HIV positive women in 18 states. The analysis was based on data collected in interviews of people with HIV conducted during 2000-2004.

Results

• Out of 2417 women surveyed, 556 (23.0%) did not report receiving a Pap test during the past year.
• Compared with those who had a recent test, women without a recent Pap test were more likely:
  • to be older (adjusted odds ratio [OR] 1.3 per 10 years);
  • to have their most recent CD4 count < 200 cells/mm³ (adjusted OR 1.6);
  • to have an unknown CD4 cell count (adjusted OR 1.4).
• The likelihood of a missed Pap test increased among women who did not received their most recent pelvic exam from their usual source of HIV care (adjusted OR 2.6).

"HIV care providers should ensure that HIV-infected women receive annual Pap tests, recognizing that missed Pap tests are more likely among older women and women with low CD4 cell counts," the study authors concluded. "Integrating HIV and gynecologic care and educating clinicians about recommendations may increase screening."

Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA.

8/14/09

Reference

AM Oster, PS Sullivan, and JM Blair. Prevalence of cervical cancer screening of HIV-infected women in the United States. Journal of Acquired Immune Deficiency Syndromes 51(4): 430-436. August 1, 2009.