NEW YORK (Reuters Health) – Even though they are at increased risk of invasive cervical cancer, nearly one in four HIV-positive women in the US who were recently interviewed had not undergone a Pap test in the previous year, investigators report.

“The risk of cervical cancer has not decreased since the introduction of (highly active antiretroviral) therapy, highlighting the continued importance of cervical cancer screening in this population,” the research team at the US Centers for Disease Control and Prevention comments in the Journal of Acquired Immune Deficiency Syndromes for August 1.

To see if guidelines for annual cervical cancer screening for this population were being performed, Dr. Alexandra M. Oster and associates used data from the Supplement to HIV/AIDS Surveillance project. Included were 2417 adult women in 18 states.

Records showed that 23% of those interviewed had not undergone a Pap test during the year before the interview.

Increasing age (adjusted odds ratio (AOR) 1.3 per 10 years) was an independent predictor of not being tested, as was the most recent CD4 count being less than 200 cells/mL (AOR 2.1), compared with a higher CD4 count.

“Because of competing priorities,” the authors suspect that preventive care for women with low CD4 counts “may be given lower priority than in other HIV-infected women. However, it is important to remember that these women are at higher risk of HPV infection and abnormal Pap test findings; thus, cervical cancer screening should be a high priority.”

Other factors that decreased the likelihood of missing a Pap test over the previous year were a history of abnormal Pap test findings (AOR = 0.6), and being pregnant (AOR 0.6) or having a sexually transmitted disease (AOR 0.4) during the previous year.

Dr. Oster’s group also observed that 45% of the subjects had their most recent pelvic exam at their usual source of HIV care, which reduced the likelihood that they had a Pap test. The highest AOR of not receiving a Pap test associated with this factor was for Hispanic women (4.8), following by white women (2.3), African American women (1.7), and women of other races (2.1)

“Integrating HIV and gynecologic care and educating clinicians about recommendations may increase screening,” Dr. Oster and associates suggest.

Reference:
J Acquir Immune Defic Synder 2009;51:430-436.