Cervical Precancer Risk in HIV-Infected Women Who Test Positive for Oncogenic Human Papillomavirus Despite a Normal Pap Test

Marla J. Keller, Robert D. Burk, L. Stewart Massad, Isam Eldin Eltoum, Nancy A. Hessol, Philip E. Castle, Kathryn Anastos, Xianhong Xie, Howard Minkoff, Xiaonan Xue, Gypsyamber D'Souza, Lisa Flowers, Alexandra M. Levine, Christine Colie, Lisa Rahangdale, Margaret A. Fischl, Joel M. Palefsky, Howard D. Strickler

Research output: Contribution to journalArticle

24 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1573-1581
Number of pages9
JournalClinical Infectious Diseases
Volume61
Issue number10
DOIs
StatePublished - Nov 15 2015

Keywords

  • HIV
  • Pap test
  • cervical cancer screening
  • human papillomavirus

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Fingerprint Dive into the research topics of 'Cervical Precancer Risk in HIV-Infected Women Who Test Positive for Oncogenic Human Papillomavirus Despite a Normal Pap Test'. Together they form a unique fingerprint.

  • Cite this

    Keller, M. J., Burk, R. D., Massad, L. S., Eltoum, I. E., Hessol, N. A., Castle, P. E., Anastos, K., Xie, X., Minkoff, H., Xue, X., D'Souza, G., Flowers, L., Levine, A. M., Colie, C., Rahangdale, L., Fischl, M. A., Palefsky, J. M., & Strickler, H. D. (2015). Cervical Precancer Risk in HIV-Infected Women Who Test Positive for Oncogenic Human Papillomavirus Despite a Normal Pap Test. Clinical Infectious Diseases, 61(10), 1573-1581. https://doi.org/10.1093/cid/civ569