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Obstetrics & Gynecology


Answer 6
  1. Perform Pap smear every 6 months for 1 year and manage according to results. All women with HIV are at higher risk of infection, with high-risk HPV types (6, 11, 16, 18) found in approximately 60% of patients.11 Approximately 40% of HIV-infected women with high-risk HPV types will have normal cytology. The clearance of HPV is strongly determined by the patient’s serum HIV viral load, and CD4 count and HIV viral load are important markers for HPV infection. Women with a CD4 count of less than 500 cells/mm3 have approximately a 9% chance of developing high-grade cervical dysplasia within 2 years as compared with 3% of women who are HIV negative or have a CD4 count of greater than 500 cells/mm3.12 All women with HIV should have an initial Pap smear. If cytology is normal, a Pap smear should be repeated in 6 months, and if these results are normal, annual screening can be continued. However, if a cytologic abnormality is found, routine evaluation such as colposcopy and directed cervical biopsies are mandated as in the management of abnormal Pap smears and cervical dysplasia in HIV-negative patients. Initial HPV testing in HIV-infected women is controversial because over 60% will have positive testing and most will not develop invasive cancer.11 There is no evidence at this time to recommend routine HPV testing in women with HIV. Patients with prior abnormal cytology and other risk factors for cervical cancer should be monitored and evaluated closely.11,12

    REFERENCES
    11. Ahdieh L, Klein RS, Burk R, et al. Prevalence, incidence, and type-specific persistence of human papillomavirus in human immunodeficiency virus (HIV)-positive and HIV-negative women. J Infect Dis 2001;184:682–90.

    12. Harris TG, Burk RD, Palefsky JM, et al. Incidence of cervical squamous intraepithelial lesions associated with HIV serostatus, CD4 cell counts, and human papillomavirus test results. JAMA 2005;293:1471–6.

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