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Healthy Women With HIV May Need Fewer Pap Tests

But researchers caution the findings need to be confirmed in additional studies

TUESDAY, March 22, 2005 (HealthDay News) -- If the results of new research are confirmed in additional studies, healthy women who are HIV-positive may be able to follow the same cervical cancer screening guidelines that HIV-negative women do.

The finding, which appears in the March 23/30 issue of the Journal of the American Medical Association, suggest that HIV-positive women who have healthy immune systems can safely get fewer Pap tests to detect cervical cancer. A reduction in screening frequency could save valuable public health dollars and spare these women additional testing anxiety, the researchers noted.

However, the authors point out that this study is only a first look at the issue, and that no recommendations are being made yet to change current cervical cancer screening guidelines.

"In countries where there is access to appropriate therapies, HIV is more and more becoming a chronic disease and people with HIV are living longer and healthier lives, so it's becoming increasingly important to know how to screen for cancer and other health conditions in these women," explained study co-author Dr. Howard D. Strickler, an associate professor in the department of epidemiology and population health at Albert Einstein College of Medicine in New York City.

Each year, 13,000 women are diagnosed with cervical cancer, and more than 4,000 die from the disease, according to the American Cancer Society. One of the biggest risk factors for developing cervical cancer is having human papillomavirus (HPV), a virus that is often sexually transmitted and can be passed simply through skin contact.

However, scientists aren't clear about how HPV increases a woman's cancer risk. Many women are infected with HPV and their bodies simply clear up the infection. But, in other women, the virus lingers and causes changes in the cells that line the cervix. These changes can eventually develop into cervical cancer.

In women with HIV and other immune-compromising disorders, these changes may occur more rapidly, said Debbie Saslow, director of breast and gynecologic cancers at the cancer society. That's why current screening guidelines for women who are HIV-positive call for more frequent screening, because earlier detection of cervical cancer increases the odds of effective treatment.

The current guidelines call for HIV-positive women to have two Pap tests six months apart following their initial HIV diagnosis. After that, HIV positive women should be screened annually.

On the other hand, HIV-negative women who are older than 30 can increase the time between their Pap smears to as long as three years if they've had three normal Pap smears in a row, or they've tested negative for the forms of HPV that are associated with cervical cancer, according to the study.

Strickler and his colleagues compared 855 healthy HIV-positive women to 343 HIV-negative women. All of the women had been participating in a larger trial called the Women's Interagency HIV Study (WIHS), and had undergone semi-annual Pap smears as part of that study.

The researchers found that 3 percent of HIV-negative women in the study had suspicious, potentially precancerous growths during the seven-year study period. Four percent of HIV-positive women who had a CD4 T-cell count of greater than 500 cells per microliter, which is a measure of how the immune system is functioning, had suspicious lesions. In contrast, HIV-positive women with a CD4 T-cell count of less than 500 cells per microliter, which suggests a flagging immune system, were diagnosed with suspicious lesions 9 percent of the time.

"If these findings are correct, then it would suggest that [healthy HIV-positive women] have similar low rates of cervical disease [to HIV-negative women over 30], and that similar Pap screening guidelines might apply to healthy HIV-positive women," said Strickler. "But these are preliminary results that shouldn't be over-interpreted."

"Screening for cervical cancer with Pap is an important health issue, especially in HIV-positive women, but no new recommendations are being made now," he said.

Saslow agreed that the current findings "don't seem strong enough to change any guidelines."

And, Dr. Mark Werner, an obstetrician/gynecologist at Beaumont Hospital in Royal Oak, Mich., pointed out that even if the guidelines were changed, women still might get more frequent screenings. He said that many of his healthy, HIV-negative patients still ask for annual Pap tests. "It would probably take some time to get women to switch to new guidelines," he said.

More information

For more information on how cervical cancer is diagnosed, visit the American Cancer Society.

SOURCES: Howard D. Strickler, M.D., M.P.H., associate professor, department of epidemiology and population health, Albert Einstein College of Medicine, New York City; Debbie Saslow, Ph.D., director, breast and gynecologic cancers, American Cancer Society, Atlanta; Mark Werner, M.D., obstetrician/gynecologist, Beaumont Hospital, Royal Oak, Mich.; March 23/30, 2005, Journal of the American Medical Association
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