Cervical Cancer Screening Guidelines for HIV-Positive Women

Initial Screening and Follow-up Protocol

The Infectious Diseases Society of America recommends that all HIV-infected women should undergo cervical Pap smear screening at the time of HIV diagnosis, with a second Pap test performed 6 months after the initial screening, and if results are normal, annually thereafter 1, 2
Women with abnormal Pap test results should undergo colposcopy and directed biopsy, with further treatment as indicated by evaluation results 1, 2

The American College of Obstetricians and Gynecologists recommends that women with atypical squamous cells, atypical glandular cells, low-grade or high-grade squamous intraepithelial lesion, or squamous carcinoma noted by Pap testing require colposcopy and directed biopsy 1, 2
Treatment should be guided by the results of the colposcopy and biopsy, with consideration of the patient's HIV status and immune function 1, 2

HIV-infected women who have had a hysterectomy, particularly those with a history of abnormal cervical cytology before or at the time of the procedure, remain at increased risk for squamous intraepithelial lesion on vaginal cytologic testing and should continue to undergo regular screening with Pap smears 3, 2
Abnormal cervical cytology is 10-11 times more common in HIV-infected women compared to the general female population, with the risk of abnormal findings associated with the presence of HPV infection and the degree of immune dysfunction 1, 2

Failing to perform the initial two Pap smears (at baseline and 6 months) before moving to annual screening can lead to delayed diagnosis and treatment of cervical abnormalities 1, 2
Neglecting to screen HIV-positive women who have undergone hysterectomy can result in missed opportunities for early detection and treatment of vaginal cytologic abnormalities 3, 2

The Centers for Disease Control and Prevention recommends performing the first Pap smear at the time of HIV diagnosis as part of the initial comprehensive gynecologic examination, and repeating it at 6 months after the initial screening to rule out false-negative results on the first test, and if both results are normal, transitioning to annual screening 4

If severe inflammation with reactive squamous cellular changes is present, the Centers for Disease Control and Prevention recommends repeating the Pap smear within 3 months 4
HIV infection alone is not an indication for colposcopy in women with normal Pap smears, according to the Centers for Disease Control and Prevention 4

Assuming that a normal initial Pap smear is sufficient ignores the high false-negative rate in HIV-positive women, as noted by the Centers for Disease Control and Prevention 4
Delaying Pap smears due to menstruation or severe cervicitis is not recommended, and the Centers for Disease Control and Prevention suggests postponing if menstruating, but if severe cervicitis is present, deferring only until after antibiotic therapy is completed 4
Performing routine colposcopy on all HIV-positive women with normal Pap smears is not indicated and represents overutilization of resources, according to the Centers for Disease Control and Prevention 4

If a woman is menstruating, the Centers for Disease Control and Prevention recommends postponing the Pap smear and rescheduling at the earliest opportunity 4
External genital warts do not require more frequent Pap smears unless otherwise indicated, as noted by the Centers for Disease Control and Prevention 4