Women With HIV May Not Need Yearly Pap Smear

A negative test for human papillomavirus (search) may mean fewer Pap smears (search) for some women with HIV infection.

HPV — especially some common strains of the sexually transmitted virus — is linked to cervical cancer (search). Women who test negative for HPV, and whose last Pap test was normal, need new Pap tests only once every three years.

Without an HPV test, women must have three consecutive normal Pap smears before switching to Pap smears every two to three years.

HIV infection raises a person's cancer risk. Current recommendations call for all HIV-positive women to get Pap smears every year. But now there's evidence that this may not be necessary if HIV-positive women have relatively intact immune systems (search) — and test negative for HPV.

Abnormal Pap Risk Similar in HPV-Negative Women Regardless of HIV Status

Tiffany G. Harris, PhD, of New York's Albert Einstein College of Medicine, and colleagues studied 855 HIV-positive women and 343 women without HIV. At the beginning of the study, the women — on average, about 35 years old — had normal Pap smear results. The researchers also tested the women for HPV infection. Then they gave them twice-yearly Pap tests.

Harris' team found that after two years, some HPV negative women with HIV infection — those with CD4+ T-cell counts over 500, indicating a relatively intact immune system — had only slightly more abnormal Pap-smear findings than HIV-negative women.

These HIV-positive/HPV-negative women may not need any more Pap smears than HIV-negative/HPV-negative women, Harris and colleagues suggest.

However, the researchers warn that only a clinical trial can prove whether this would truly be safe. Until such a trial can be conducted, they do not advise changing the current recommendation that HIV-positive women get annual Pap smears.

Harris and colleagues report their findings in the March 23/30 issue of The Journal of the American Medical Association.

By Daniel J. DeNoon, reviewed by Brunilda Nazario, MD

SOURCE: Harris, T.G. The Journal of the American Medical Association, March 23/30, 2005; vol 293: pp 1471-1476.