TABLE 4

Cervical cancer screening and management among individuals with HIV

Screening
Age to startAge to stopRecommended test and frequencyRationale
Screening should begin at time of diagnosis but not before age 21Screening should continue throughout a patient’s lifetime (considering life expectancy)aAge < 30 years
Cytology (Pap test) at baseline, then annually
If 3 consecutive Pap tests are normal, then cytology every 3 years (until age 30)		Age ≥ 30 years
Choose between cytology (Pap test) at baseline, then annually (if not already completed before age 30); if 3 consecutive Pap tests are normal, then cytology every 3 years or cotesting every 3 years		Begin screening at age 21 to provide a 3–5-year window before age 25, when the risk of invasive cervical cancer in patients with HIV exceeds that of the general population20; while historically screening was done before age 21, patients rarely develop cervical cancer before age 2121
In patients age < 30, cotesting is not recommended due to a high prevalence of transient HPV in this age group3
Management
Regardless of age, colposcopy is recommended in the following scenarios:

  • HPV-positive ASC-US; if HPV testing is not performed, then repeat cytology in 6–12 months is recommended, with colposcopy referral for ASC-US or worse

  • All cytology results of low-grade squamous intraepithelial lesion or worse (including ASC-H, atypical glandular cells, adenocarcinoma in situ, and high-grade squamous intraepithelial lesion) regardless of HPV test results (if completed)

  • ↵a If a patient with HIV undergoes a hysterectomy with removal of cervix (total hysterectomy) for benign disease and has no history of cervical intraepithelial neoplasia 2+, then ongoing routine screening for cervical or vaginal cancer is generally not recommended.

  • ASC-H = atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion; ASC-US = atypical squamous cells of undetermined significance; HIV = human immunodeficiency virus; HPV = human papillomavirus; Pap = Papanicolaou

  • Data from references 3 and 16.