Abstract 2580: Optimizing cervical cancer screening for HIV-infected women: A risk-based approach

Abstract

Abstract Background: Women living with HIV (WLHIV) have increased cervical cancer risk. Guidelines suggest screening WLHIV with negative cervical cytology annually, and managing WLHIV with ASC-US cytology by general population (GP) guidelines (1 year return if HPV testing unavailable). Methods: We used risk benchmarking to compare cervical precancer risk in WLHIV to the GP. For WLHIV ages 21-65 years in the Women's Interagency HIV Study (WIHS), we evaluated the first cytology result from 2000 or later. We used parametric survival models to calculate HSIL risks after negative or ASC-US cytology, overall and by CD4 cell count. Separately, we synthesized HSIL risk estimates among GP women in 13 published studies using mixed-effects models. We then benchmarked risks in WLHIV to the 3-year GP risks, which for negative cytology represent the threshold for re-screening. Results: Among 2,653 WLHIV, 1,982 (75%) had negative cytology and 377 (14%) had ASC-US cytology. Most WLHIV with negative (72%) and ASC-US (52%) cytology had CD4≥350 cells/μL. We observed 95 cases of HSIL (CIN2+; 44 were CIN3+ including 1 cancer) within 5 years of cytology. After negative cytology, 3-year GP risk “benchmarks” were 0.83% (CIN2+) and 0.60% (CIN3+). WLHIV with CD4≥350 met both benchmarks by 2 years (1.1% and 0.68% respectively), while WLHIV with CD4<350 exceeded the CIN2+ benchmark at only 1 year (1.1%). After ASC-US cytology, 3-year GP benchmarks were 8.7% (CIN2+) and 4.4% (CIN3+). For WLHIV with CD4≥350, 3-year risks were similar to the benchmarks (9.4% and 4.0%), but WLHIV with CD4<350 approximated these risks at only 1 year (8.8% and 3.9%). Conclusions: For WLHIV with CD4≥350, these data suggest that the interval for re-screening after negative cervical cytology can be lengthened from 1 to 2 years, and that inclusion in GP guidelines for managing ASC-US cytology is appropriate. In contrast, WLHIV with CD4<350 remain at increased risk and should be screened annually after negative cervical cytology and referred to colposcopy after ASC-US. Cervical precancer risk after normal or ASC-US cytology in WLHIV compared to the general populationHSIL (CIN2+) risk,%HSIL (CIN2+) risk,%HSIL (CIN2+) risk,%HSIL (CIN3+) risk,%HSIL (CIN3+) risk,%HSIL (CIN3+) risk,%1 year2 years3 years1 year2 years3 yearsNEGATIVE CYTOLOGY:General population benchmark0.830.60HIV+, overall (N = 1,982)0.621.32.00.330.681.0HIV+, CD4≥350 (N = 1,393)0.471.11.70.380.680.96HIV+, CD4<350 (N = 542)1.12.02.80.240.651.1ASC-US CYTOLOGY:General population benchmark8.74.4HIV+, overall (N = 377)7.310.112.23.24.35.2HIV+, CD4≥350 (N = 191)5.57.89.42.53.34.0HIV+, CD4<350 (N = 175)8.812.815.93.95.56.8 Citation Format: Hilary A. Robbins, L. Stewart Massad, Christopher B. Pierce, Lisa Flowers, Teresa M. Darragh, Howard Minkoff, Lisa Rahangdale, Marla J. Keller, Joel Milam, Margaret Fischl, Sadeep Shrestha, Christine Colie, Howard Strickler, Gypsyamber D’Souza. Optimizing cervical cancer screening for HIV-infected women: A risk-based approach. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2580.