HPV co-testing prospect for HIV-infected women

By MedWire Reporters

The risk for cervical precancer and cancer is similar in HIV-infected and HIV-uninfected women with normal cervical cytology and no evidence of oncogenic human papillomavirus (HPV) infection, research shows.

Specifically, the 5-‑ear incidence of high-grade squamous intraepithelial lesions (HSIL+) or cervical intraepithelial neoplasia 2 or greater (CIN-2+) was similar in HIV‑infected and HIV‑uninfected women.

"Few cases of cervical precancer would have gone undiagnosed had the HIV‑infected women not had any additional Pap tests for 5 years following enrollment and no more than in the HIV-uninfected women," say the researchers.

Reporting in JAMA, lead investigator Marla Keller (Albert Einstein College of Medicine, New York, USA) and team note that US cervical cancer screening guidelines in women without HIV have recently been revised.

Dubbed HPV co-testing, the cervical cancer screening guidelines recommend the use of oncogenic HPV DNA testing concurrent with cervical cytology in women without HIV.

Women without HIV and a normal Pap test result who are positive for oncogenic HPV should be rescreened at 1 year. The interval for rescreening women oncogenic HPV‑negative was recently increased from 3 to 5 years.

"These recommendations reflect the low risk of cervical precancer and cancer observed in cytologically normal, oncogenic HPV-negative women during long-term follow-up," according to Keller and colleagues.

In the present study, the group wanted to determine if a 3‑year or 5‑year screening interval could also be used in HIV-infected women who are cytologically normal and oncogenic HPV‑negative.

No oncogenic HPV was documented in 88% of the 420 HIV-infected women and 91% of 279 HIV‑uninfected women with normal cervical cytology at enrollment.

Among the oncogenic HPV‑negative women, two cases of HSIL+ were reported, including one in an HIV-infected woman with a CD4 cell count of 500 cells/µL and one in an HIV-uninfected woman.

In total, there were six cases of CIN-2+ among HIV-uninfected women (5%) and nine among the HIV‑infected women (5%), a nonsignificant difference. Two HIV-infected women had CIN-3, with a 5‑year cumulative incidence of 0.5%, but none had cancer.

Despite the similar risks for precancer and cancer in the HIV‑infected and HIV‑uninfected women, the researchers say that additional observational studies or a randomized, clinical trial may be needed before expanding HPV co-testing to HIV‑infected women.

The present study highlights the potential for a new era of molecular testing, including HPV and other biomarkers, to improve cervical cancer screening in HIV‑infected women, they add.

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