RISK OF CERVICAL CANCER NO HIGHER IN HIV+ WOMEN

July 25, 2012 (Washington, DC) — The 5-year cumulative incidence of squamous epithelial intraepithelial lesions that are high grade or greater (HSIL+) and carcinoma in situ (CIN) was similar in HIV-positive and HIV-negative women who had cytologically normal Pap tests, according to new researchMarla J. Keller, MD, from the Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, and colleagues set out to determine the risk for cervical precancer or cancer in the Women's Interagency HIV Study.

The results of that study were published in the July 25 issue of JAMA, but were released early here at AIDS 2012: XIX International AIDS Conference.

The researchers enrolled 420 HIV-infected women and 279 HIV-uninfected women between October 1, 2001 and September 30, 2002. Patients were followed until April 30, 2011. The women underwent semiannual Pap testing and cervical biopsy, if indicated. Cervicovaginal lavage specimens were tested for human papillomavirus (HPV) DNA using polymerase chain reaction. Dr. Keller reported 5-year follow-up data.

In women with normal cervical cytology at enrollment, there was no oncogenic HPV was detected in 369 HIV-infected women (88%; 95% confidence interval [CI], 84% to 91%) or in 255 HIV-uninfected women (91%; CI, 88% to 94%).

There were 6 cases of CIN-2 or greater in 145 HIV-uninfected women (cumulative incidence, 5%; 95% CI, 1% to 8%) and 9 cases in HIV-infected women (cumulative incidence, 5%; 95% CI, 2% to 8%). One HIV-infected patient and 1 HIV-uninfected patient had CIN-3; none had cancer.

"The 5-year cumulative incidence of HSIL+ and CIN-2+ was similar in HIV-infected women and HIV-uninfected women who were cytologically normal and oncogenic HPV-negative at enrollment," Dr. Keller and colleagues concludeMedscape Medical News invited Debbie Saslow, PhD, director of breast and gynecologic cancers at the American Cancer Society in Atlanta, Georgia, to comment on the study.

"This paper is very well done and very encouraging, but I'm a little concerned by the small numbers. There were so few abnormal Pap tests and no cancers. With cervical cancer, you have to have a really large sample size, although it's much more common in women who are HIV-positive," Dr. Saslow explained.

Small numbers notwithstanding, Dr. Saslow called the findings from the study "encouraging" for HIV-positive women. "HIV-positive women who have negative Pap screen results can be screened less often. But this is only for HIV-positive women who have negative screening results. Anyone who is HIV-positive who has a positive screening result needs to take that very seriously."

The study was funded by the National Institutes of Health. Dr. Keller and Dr. Saslow have disclosed no relevant financial relationships.

JAMA. 2012;308:362-369. Abstract