Follow-Up of Papanicolaou (Pap) in HIV-positive and HIV-negative Wom - Abstract
Introduction: Persistent high-risk HPV (hrHPV) is considered a risk for the progression from pre-cancer to invasive cervical cancer (ICC). According to viral profiles, persistence of hrHPV infection may present as a chronic persistent infection or reinfection. Limited data exists regarding persistence of hrHPV in HIV-infected and -uninfected individuals. Methods: We tracked the Papanicolaou (Pap) results in forty-seven HIV-positive and 304 HIV-negative women five years after baseline testing. Results: Follow-up Pap results were available in twenty-one of the forty-seven (45%) HIV-positive and thirty-seven of the 304 (12%) HIV-negative women. On follow-up, HIV-positive women were significantly (p=0.002) more likely to be at higher risk of persistent hrHPV infection and abnormal cytology (LGSIL/HGSIL) than their negative counterparts. In both the baseline and follow-up studies, hrHPV was significantly (p=0.000) associated with abnormal cytology in both HIV-positive and -negative women. HIV-positive women were significantly (p= 0.001) more likely than their negative counterparts to have missed an opportunity to reassess their hrHPV status with follow-up Pap testing. Conclusion: HIV-positive women remain at significantly higher risk for a persistent hrHPV infection and abnormal cervical cytology than their HIV-negative counterparts. Both HIV-positive and -negative women have evidence of poor compliance with follow-up Pap testing. Among all ethnic groups enrolled in the baseline study, Hispanic women were most likely to have missed follow-up Pap testing. Whether persistence of abnormal Pap is due to chronic persistent infection or reinfection cannot be determined from this study. Further studies involving a larger sample size to demonstrate persistence patterns are recommended.