HIV doesn't increase risk of cervical cancer

• Cumulative incidence of high-grade SIL similar in HIV-negative and –positive women

• HPV negativity key but CD4 cell count not a factor in risk

Women infected with HIV are at no greater risk of cervical cancer than uninfected women, as long as they are human papillomavirus (HPV)-negative and have normal cervical cytology, according to the findings of a recent study.

As part of the Women’s Interagency HIV Study (WIHS), a multicenter cohort study funded by the National Institutes of Health, researchers looked at 420 HIV-positive women and 279 HIV-negative women. All of the women had normal cervical cytology at study enrollment. The researchers saw the women semiannually and performed biopsies if Pap testing was positive.

The investigators detected no oncogenic HPV in 88% of the HIV-infected women and in 91% of the uninfected women. They noted 2 cases of high-grade squamous intraepithelial lesions (SIL), one in an HIV-negative woman and one in an HIV-infected woman with a CD4 cell count ≥ 500 cells/µL. Histologic data from 4 of the 6 study sites also revealed 6 cases of cervical intraepithelial neoplasia (CIN)-2+ in 145 HIV-uninfected women and 9 cases in 219 HIV-positive women.

Published in JAMA, the results show that after 5 years of follow-up, no differences existed between the 2 groups in the cumulative incidence of high-grade SIL or CIN-2. Cumulative incidence was comparable at 5%, regardless of CD4 cell counts. Although 2 of the HIV-infected women ended up having CIN-3, none of the women in the study had cancer through 9 years of follow-up.

The authors of the study cautioned that their findings may not be generalizable. Unlike many women in the population at large, the women in the WIHS are participating in long-term follow-up.

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