Cervical Precancer Risk in HIV-Infected Women Who Test Positive for Oncogenic Human Papillomavirus Despite a Normal Pap Test

Marla J. Keller, Robert D. Burk, L. Stewart Massad, Isam Eldin Eltoum, Nancy A. Hessol, Philip E. Castle, Kathryn Anastos, Xianhong Xie, Howard Minkoff, Xiaonan (Nan) Xue, Gypsyamber D'Souza, Lisa Flowers, Alexandra M. Levine, Christine Colie, Lisa Rahangdale, Margaret A. Fischl, Joel M. Palefsky, Howard Strickler

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background.Determining cervical precancer risk among human immunodeficiency virus (HIV)-infected women who despite a normal Pap test are positive for oncogenic human papillomavirus (oncHPV) types is important for setting screening practices. Methods.A total of 2791 HIV-infected and 975 HIV-uninfected women in the Women's Interagency HIV Study were followed semiannually with Pap tests and colposcopy. Cumulative risks of cervical intraepithelial neoplasia grade 2 or greater (CIN-2+; threshold used for CIN treatment) and grade 3 or greater (CIN-3+; threshold to set screening practices) were measured in HIV-infected and HIV-uninfected women with normal Pap tests, stratified by baseline HPV results, and also in HIV-infected women with a low-grade squamous intraepithelial lesion (LSIL; benchmark indication for colposcopy). Results.At baseline, 1021 HIV-infected and 518 HIV-uninfected women had normal Pap tests, of whom 154 (15%) and 27 (5%), respectively, tested oncHPV positive. The 5-year CIN-2+ cumulative risk in the HIV-infected oncHPV-positive women was 22% (95% confidence interval [CI], 9%-34%), 12% (95% CI, 0%-22%), and 14% (95% CI, 2%-25%) among those with CD4 counts

Original languageEnglish (US)
Pages (from-to)1573-1581
Number of pages9
JournalClinical Infectious Diseases
Volume61
Issue number10
DOIs
StatePublished - Nov 15 2015

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Papanicolaou Test
HIV
Colposcopy
Confidence Intervals
Benchmarking
Cervical Intraepithelial Neoplasia
CD4 Lymphocyte Count

Keywords

  • cervical cancer screening
  • HIV
  • human papillomavirus
  • Pap test

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Cervical Precancer Risk in HIV-Infected Women Who Test Positive for Oncogenic Human Papillomavirus Despite a Normal Pap Test. / Keller, Marla J.; Burk, Robert D.; Massad, L. Stewart; Eltoum, Isam Eldin; Hessol, Nancy A.; Castle, Philip E.; Anastos, Kathryn; Xie, Xianhong; Minkoff, Howard; Xue, Xiaonan (Nan); D'Souza, Gypsyamber; Flowers, Lisa; Levine, Alexandra M.; Colie, Christine; Rahangdale, Lisa; Fischl, Margaret A.; Palefsky, Joel M.; Strickler, Howard.

In: Clinical Infectious Diseases, Vol. 61, No. 10, 15.11.2015, p. 1573-1581.

Research output: Contribution to journalArticle

Keller, MJ, Burk, RD, Massad, LS, Eltoum, IE, Hessol, NA, Castle, PE, Anastos, K, Xie, X, Minkoff, H, Xue, XN, D'Souza, G, Flowers, L, Levine, AM, Colie, C, Rahangdale, L, Fischl, MA, Palefsky, JM & Strickler, H 2015, 'Cervical Precancer Risk in HIV-Infected Women Who Test Positive for Oncogenic Human Papillomavirus Despite a Normal Pap Test', Clinical Infectious Diseases, vol. 61, no. 10, pp. 1573-1581. https://doi.org/10.1093/cid/civ569
Keller, Marla J. ; Burk, Robert D. ; Massad, L. Stewart ; Eltoum, Isam Eldin ; Hessol, Nancy A. ; Castle, Philip E. ; Anastos, Kathryn ; Xie, Xianhong ; Minkoff, Howard ; Xue, Xiaonan (Nan) ; D'Souza, Gypsyamber ; Flowers, Lisa ; Levine, Alexandra M. ; Colie, Christine ; Rahangdale, Lisa ; Fischl, Margaret A. ; Palefsky, Joel M. ; Strickler, Howard. / Cervical Precancer Risk in HIV-Infected Women Who Test Positive for Oncogenic Human Papillomavirus Despite a Normal Pap Test. In: Clinical Infectious Diseases. 2015 ; Vol. 61, No. 10. pp. 1573-1581.
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abstract = "Background.Determining cervical precancer risk among human immunodeficiency virus (HIV)-infected women who despite a normal Pap test are positive for oncogenic human papillomavirus (oncHPV) types is important for setting screening practices. Methods.A total of 2791 HIV-infected and 975 HIV-uninfected women in the Women's Interagency HIV Study were followed semiannually with Pap tests and colposcopy. Cumulative risks of cervical intraepithelial neoplasia grade 2 or greater (CIN-2+; threshold used for CIN treatment) and grade 3 or greater (CIN-3+; threshold to set screening practices) were measured in HIV-infected and HIV-uninfected women with normal Pap tests, stratified by baseline HPV results, and also in HIV-infected women with a low-grade squamous intraepithelial lesion (LSIL; benchmark indication for colposcopy). Results.At baseline, 1021 HIV-infected and 518 HIV-uninfected women had normal Pap tests, of whom 154 (15{\%}) and 27 (5{\%}), respectively, tested oncHPV positive. The 5-year CIN-2+ cumulative risk in the HIV-infected oncHPV-positive women was 22{\%} (95{\%} confidence interval [CI], 9{\%}-34{\%}), 12{\%} (95{\%} CI, 0{\%}-22{\%}), and 14{\%} (95{\%} CI, 2{\%}-25{\%}) among those with CD4 counts",
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AU - Burk, Robert D.

AU - Massad, L. Stewart

AU - Eltoum, Isam Eldin

AU - Hessol, Nancy A.

AU - Castle, Philip E.

AU - Anastos, Kathryn

AU - Xie, Xianhong

AU - Minkoff, Howard

AU - Xue, Xiaonan (Nan)

AU - D'Souza, Gypsyamber

AU - Flowers, Lisa

AU - Levine, Alexandra M.

AU - Colie, Christine

AU - Rahangdale, Lisa

AU - Fischl, Margaret A.

AU - Palefsky, Joel M.

AU - Strickler, Howard

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N2 - Background.Determining cervical precancer risk among human immunodeficiency virus (HIV)-infected women who despite a normal Pap test are positive for oncogenic human papillomavirus (oncHPV) types is important for setting screening practices. Methods.A total of 2791 HIV-infected and 975 HIV-uninfected women in the Women's Interagency HIV Study were followed semiannually with Pap tests and colposcopy. Cumulative risks of cervical intraepithelial neoplasia grade 2 or greater (CIN-2+; threshold used for CIN treatment) and grade 3 or greater (CIN-3+; threshold to set screening practices) were measured in HIV-infected and HIV-uninfected women with normal Pap tests, stratified by baseline HPV results, and also in HIV-infected women with a low-grade squamous intraepithelial lesion (LSIL; benchmark indication for colposcopy). Results.At baseline, 1021 HIV-infected and 518 HIV-uninfected women had normal Pap tests, of whom 154 (15%) and 27 (5%), respectively, tested oncHPV positive. The 5-year CIN-2+ cumulative risk in the HIV-infected oncHPV-positive women was 22% (95% confidence interval [CI], 9%-34%), 12% (95% CI, 0%-22%), and 14% (95% CI, 2%-25%) among those with CD4 counts

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