Frequent Cervical Cancer Screenings Are Still Important for Women With HIV

You may have seen that newly revised recommendations were announced by the American College of Obstetricians and Gynecologists regarding cervical cancer screening. These revised recommendations call for less-frequent cervical cancer screening: a Pap smear once every two years for women between the ages of 21 and 30, and once every three years for women 30 and up who have had three consecutive negative test results.

It's important to note that the recommendations do not apply to HIV-positive women. Women with HIV are a noted exception, and that's because many studies have indicated that HIV-positive women are at greater risk than HIV-negative women for HPV-16 and HPV-18, the two strains of human papillomavirus (HPV) that cause most cases of cervical cancer. In addition, HPV infection in HIV-positive women is more likely to progress to cervical cancer.

Cervical cancer is one of the diseases on the official list of AIDS-defining conditions. In fact, the risk of cervical cancer has not decreased since the introduction of HAART (highly active antiretroviral therapy), making it important that women with HIV be monitored closely for cervical cancer. And yet, a recent study showed that about one in four HIV-positive women in the U.S. are not getting Pap smears as frequently as they should.

How often should HIV-positive women get screened? Guidelines issued by the Infectious Diseases Society of America (IDSA) earlier this year recommend that HIV-positive women get a Pap test (along with other initial monitoring tests) when they are first diagnosed with HIV, and that this test be repeated six months later. If the first two Pap tests are normal, then Pap tests should be given annually thereafter.

The IDSA guidelines also recommend that more frequent Pap tests be considered if an HIV-positive woman has had a previous abnormal Pap test, has symptomatic HIV or is infected with HPV. HIV-positive women who have had a hysterectomy -- particularly if they have had a history of abnormal cervical tests before or at the time of the hysterectomy -- are also at increased risk for cervical cancer and should receive more frequent cervical cancer screenings.

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