Safety Against Cervical Precancer and Cancer Following Negative Human Papillomavirus and Papanicolaou Test Results in Human Immunodeficiency Virus–Infected Women

The American Cancer Society (ACS) first recommended cotesting (cervical cytologic and human papillomavirus [HPV] DNA testing) as an acceptable alternative to routine cervical cytologic testing alone for cervical cancer screening in 2002.¹ The ACS recommendations included extending the screening interval to not less than 3 years for those women who tested negative for both tests (“negative cotest”).

Human immunodeficiency virus (HIV) infection, and its clinical manifestation of AIDS, is a known risk factor for cervical precancer² and cancer,³ and cervical cancer is considered an AIDS-defining malignancy. Current guidelines⁴ for cervical cancer screening recommend Papanicolaou (Pap) testing twice during the first year after diagnosis of HIV infection and, if the results are normal, annually thereafter. It is unknown whether a negative cotest result might provide similar safety for HIV-infected women as it does for HIV-negative women. Thus, the objective of this analysis was to assess the risk of cervical precancer and cancer following a negative cotest result in HIV-seropositive women 30 years and older.