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Paps & Colposcopies

Winter 1998-1999

A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

Well, its that time of year. Time for me to call the Doc for a pap smear.

Pap smears are right up there with root canals and shoving knitting needles in my eyes. I hate them! But I have come to realize how important they are.

Cervical cancer is the first and only AIDS defining OI exclusive to women on the official CDC list. And that's because women with HIV are more likely to develop cervical cancer than other women. The possibility increased to 30 times more likely if you have HIV and HPV, the human papilloma virus.

In fact, if you are HIV positive, you might ask your GYN to test you for HPV. Its the virus that causes genital warts, but has also been tied to a higher incidence of cervical cancer in women and anal cancer in men.

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So, I'm gonna grit my teeth and call my doc and set up an appointment. They say HIV positive women should have a pap smear every year, every six months if you have both HIV and HPV. My year is up.


More About Paps

From WA Treatment Advocacy Program

Pap smears are studied by Pathologists and cytotechnologists, who are trained in the microscopic examination of cells (cytology). The cell samples are treated with a stain that highlights the abnormal cells. Many clinicians and patients believe that HIV can cause false readings. The class system is used to report normal to progressively abnormal cells.


Colposcopy

The debate on the usefulness of pap smears for HIV+ women continues. Pap smears are less sensitive than colposcopy. Colposcopy would be favored over just pap testing for women who are at high risk for developing cervical abnormalities.

Recurrence rates of CIN (Cervical Intraepithelial Neoplasia) after standard treatment in HIV positive women are high and recurrence is related to immune status. Therapeutic strategies that address treatment failures should be developed for HIV+ women.

Cervical abnormalities are strongly associated with infection with the human-papilloma virus (HPV) in both HIV+ and HIV negative women. HIV positive women are much more likely to become newly infected with HPV and to have persistent HPV infection. Many more HIV+ women than negative women are HPV positive.

Cervical Intraepithelial Neoplasia (CIN) is cellular changes in the cervix, thought to be precursors of cervical cancer. Researchers conclude that HIV+ women are three times more likely as HIV negative women to have CIN. HPV infection is the major risk factor for CIN in both groups.

The initial diagnosis of an HIV infected woman should include a Pap smear and a complete physical examination, including a thorough gynecological and anal evaluation.


Risk

Risk factors for SIL (squamous intra-epithelial lesion) and HIV infection are similar, and women with SIL or invasive cervical cancer should be counseled and encouraged to be tested for HIV. Additionally, at each clinic visit, HIV infected women should be reminded to use condoms.


Guidelines for Pap Smear Testing in HIV+ Women

  • Normal smears should be followed with a second smear 6 months later to rule out a false-negative. If both results are normal, subsequent Pap smears should be performed annually.

  • Pap smears showing severe inflammation or reactive squamous cell changes should be followed by another smear in 3 months.

  • Diagnosis of a squamous intra-epithelial lesion (SIL) or atypical squamous cells of undetermined significance should be followed with colpo-scopic examination of the lower genital tract.

Many women believe that these guidelines are not good enough. Who has 6 months to wait to see if her pap was a false normal? If it was a false normal, in 6 months, cancer can be advanced and irreversible. Then another 3 months wait when the pap does show abnormalities. That's a total of 9 months. Women can be dead from many gyn conditions in that length of time. Another wait for lab results. Then finally, a colposcopy to find out what the real problem is.


Women's Lives

These guidelines will jeopardize the lives of women with HIV/AIDS. These guidelines neither reflect the most current scientific information, nor do they allow the opportunity to stay ahead of the alarming incidence of cervical cancer in women with HIV.

Pap smears must not be used simply because they are an inexpensive screening technique. The alarming incidence of CIN in HIV infected women coupled with the fact that pap smears miss 25% of all dysplasia, put HIV infected women at increased risk of undetected and untreated cervical cancer.

At a clinic in Los Angeles, 50% of HIV infected women with negative pap smears were positive for some form of dysplasia upon colposcopic examination. Women's lives depend on early detection by definitive diagnosis of CIN. Colposcopy, regardless of cost, should be a routine option for women with HIV infection. (Key word "option" -- because who wants to get a biopsy of their cervix every six months?) It is important to detect cervical cancer in women early-on, in order to treat it effectively.

When an HIV infected woman is referred for colposcopic examination and therapy, decisions about care for the woman should be made in collaboration with her HIV-care provider.


80%

In one study 80% of HIV positive women with T-cell counts greater than 500 had CIN. Anal HPV infection and disease were at least as common as cervical disease.

Regular gynecological monitoring and early treatment for such conditions are essential. Researchers conclude that improvement is needed in both inpatient and outpatient clinical settings. They recommend providing gynecological care to women hospitalized for any condition, for preventive reasons. The main problems are that many women being treated for HIV are not receiving appropriate gynecological care, and many HIV+ women receiving gynecological care are either unaware of, or choose not to disclose, their serostatus. Since obstetricians/gynecologists may be the only doctors that many women see, residents in training for the ob/gyn specialty should receive HIV education and training.


On Q Jodi, Produces a Women and HIV newsletter on America On Line, Published by On Q's Positive Living Forum. Their newsletter is best viewed using AOL version 3.0. If you are not using this version, you can download it FREE in the Members' Services area. There is also a Positive Women's Chat Session: Positive Living Forum -- Positive Living Forum Area Advisor. Please visit them in the Positive Living Forum of the On Q by going to keyword: HIV On Q.


Back to the Women Alive Winter 1998-99 Contents Page.

A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!



  
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This article was provided by Women Alive. It is a part of the publication Women Alive Newsletter.
 
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HIV/AIDS Resource Center for Women
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