by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

May 18, 2021

Featured Literature:

Massad LS, Xie X, Minkoff HL, et al.  Frequency of high grade squamous cervical lesions among women over age 65 years living with the human immunodeficiency virus.  Am J Obstet Gynecol.  2021 May 3; S0002-9378(21)00535-4. doi: 10.1016/j.ajog.2021.04.253.  PMID: 33957115.

Current guidelines for cervical cancer screening cessation differ by HIV status: specifically, screening in women with HIV is recommended throughout a woman’s lifetime (i.e., not end at 65 years of age as recommended for the general population).  This analysis, utilizing data from the WIHS cohort, attempted to determine the proportion of women reaching age 65 years who would be eligible to end screening and the incidence of subsequent high grade squamous intraepithelial lesions (HSIL) among such women.  Pap testing data through September 2019 for 169 eligible participants (121 women with HIV, 48 seronegative women) were analyzed.  2.2% had high grade cytologic abnormalities; no cancers were diagnosed during follow-up.  Twenty women had prior precancer and 74 had abnormal Pap results within the prior decade.  48 women (27 women with HIV, 21 without HIV) met current guidelines to stop screening; their risk of HSIL was 2.2/100 woman-years overall and did not vary by HIV status (2.3 versus 1.8/100 woman-years, p=0.81).

Author’s Commentary:

Optimal cancer screening for people aging with HIV remains an important topic of HIV medicine, and this analysis provides data that might help guide information-sharing and shared decision making for women with HIV who are 65+ years of age and their providers.  Investigators found that most women with HIV who reach age 65 do not meet criteria for exiting screening.  However, for those who do meet criteria, HSIL risk is similar to the risk observed among seronegative women.  Thus, authors suggest ‘women living with HIV should be offered the option of screening cessation as part of an informed discussion of the risks and potential benefits of screening, recognizing that the 2% annual HSIL risk … may persuade many in good health to continue screening’.  It is also worth noting that many patients have limited documentation of prior screening/testing results (which might be avoidable at times), often leading to challenges in confident decision making regarding ongoing screening.        

The author has no conflicts of interest to disclose.

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