Cervical cancer screening intervals and management for women living with HIV: A risk benchmarking approach

Hilary A. Robbins, Howard D. Strickler, L. Stewart Massad, Christopher B. Pierce, Teresa M. Darragh, Howard Minkoff, Marla J. Keller, Margaret Fischl, Joel Palefsky, Lisa Flowers, Lisa Rahangdale, Joel Milam, Sadeep Shrestha, Christine Colie, Gypsyamber D'Souza

Research output: Research - peer-reviewReview article

  • 2 Citations

Abstract

Objective: We suggested cervical cancer screening strategies for women living with HIV (WLHIV) by comparing their precancer risks to general population women, and then compared our suggestions with current Centers for Disease Control and Prevention (CDC) guidelines. Design: We compared risks of biopsy-confirmed cervical high-grade squamous intraepithelial neoplasia or worse (bHSIL+), calculated among WLHIV in the Women's Interagency HIV Study, to 'risk benchmarks' for specific management strategies in the general population. Methods: We applied parametric survival models among 2423 WLHIV with negative or atypical squamous cell of undetermined significance (ASC-US) cytology during 2000'2015. Separately, we synthesized published general population bHSIL+ risks to generate 3-year risk benchmarks for a 3-year return (after negative cytology, i.e. 'rescreening threshold'), a 6'12-month return (after ASC-US), and immediate colposcopy [after low-grade squamous intraepithelial lesion (LSIL)]. Results: Average 3-year bHSIL+ risks among general population women ('risk benchmarks) were 0.69% for a 3-year return (after negative cytology), 8.8% for a 612-month return (after ASC-US), and 14.4% for colposcopy (after LSIL). Most CDC guidelines for WLHIV were supported by comparing risks in WLHIV to these benchmarks, including a 3-year return with CD4+ greater than 500 cells/ml and after either three negative cytology tests or a negative cytology/oncogenic human papillomavirus cotest (all 3-year risks≤1.3%); a 1-year return after negative cytology with either positive oncogenic human papillomavirus cotest (1-year risk=1.0%) or CD4+ cell count less than 500 cells/ml (1-year risk=1.1%); and a 612-month return after ASC-US (3-year risk=8.2% if CD4+ cell count at least 500 cells/ml; 10.4% if CD4+ cell count=350499 cells/μl). Other suggestions differed modestly from current guidelines, including colposcopy (vs. 612 month return) for WLHIV with ASC-US and CD4+ cell count less than 350 cells/μl (3-year risk=16.4%) and a lengthened 2-year (vs. 1-year) interval after negative cytology with CD4+ cell count at least 500 cells/ml (2-year risk=0.98%). Conclusions: Current cervical cancer screening guidelines for WLHIV are largely appropriate. CD4 cell count may inform risk-tailored strategies.

LanguageEnglish (US)
Pages1035-1044
Number of pages10
JournalAIDS
Volume31
Issue number7
DOIs
StatePublished - Apr 24 2017

Fingerprint

Benchmarking
Early Detection of Cancer
Uterine Cervical Neoplasms
HIV
Cell Biology
Cell Count
Atypical Squamous Cells of the Cervix
Guidelines
Population
Colposcopy
Centers for Disease Control and Prevention (U.S.)
Squamous Intraepithelial Lesions of the Cervix
CD4 Lymphocyte Count
Biopsy
Survival
Neoplasms

Keywords

  • Benchmarking
  • CD4
  • Cervical cancer
  • Cervical intraepithelial neoplasia
  • High-grade squamous intraepithelial neoplasia
  • HIV
  • Precancer
  • Risk
  • Screening guidelines

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Robbins, H. A., Strickler, H. D., Massad, L. S., Pierce, C. B., Darragh, T. M., Minkoff, H., ... D'Souza, G. (2017). Cervical cancer screening intervals and management for women living with HIV: A risk benchmarking approach. AIDS, 31(7), 1035-1044. DOI: 10.1097/QAD.0000000000001450

Cervical cancer screening intervals and management for women living with HIV : A risk benchmarking approach. / Robbins, Hilary A.; Strickler, Howard D.; Massad, L. Stewart; Pierce, Christopher B.; Darragh, Teresa M.; Minkoff, Howard; Keller, Marla J.; Fischl, Margaret; Palefsky, Joel; Flowers, Lisa; Rahangdale, Lisa; Milam, Joel; Shrestha, Sadeep; Colie, Christine; D'Souza, Gypsyamber.

In: AIDS, Vol. 31, No. 7, 24.04.2017, p. 1035-1044.

Research output: Research - peer-reviewReview article

Robbins, HA, Strickler, HD, Massad, LS, Pierce, CB, Darragh, TM, Minkoff, H, Keller, MJ, Fischl, M, Palefsky, J, Flowers, L, Rahangdale, L, Milam, J, Shrestha, S, Colie, C & D'Souza, G 2017, 'Cervical cancer screening intervals and management for women living with HIV: A risk benchmarking approach' AIDS, vol 31, no. 7, pp. 1035-1044. DOI: 10.1097/QAD.0000000000001450
Robbins HA, Strickler HD, Massad LS, Pierce CB, Darragh TM, Minkoff H et al. Cervical cancer screening intervals and management for women living with HIV: A risk benchmarking approach. AIDS. 2017 Apr 24;31(7):1035-1044. Available from, DOI: 10.1097/QAD.0000000000001450
Robbins, Hilary A. ; Strickler, Howard D. ; Massad, L. Stewart ; Pierce, Christopher B. ; Darragh, Teresa M. ; Minkoff, Howard ; Keller, Marla J. ; Fischl, Margaret ; Palefsky, Joel ; Flowers, Lisa ; Rahangdale, Lisa ; Milam, Joel ; Shrestha, Sadeep ; Colie, Christine ; D'Souza, Gypsyamber. / Cervical cancer screening intervals and management for women living with HIV : A risk benchmarking approach. In: AIDS. 2017 ; Vol. 31, No. 7. pp. 1035-1044
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abstract = "Objective: We suggested cervical cancer screening strategies for women living with HIV (WLHIV) by comparing their precancer risks to general population women, and then compared our suggestions with current Centers for Disease Control and Prevention (CDC) guidelines. Design: We compared risks of biopsy-confirmed cervical high-grade squamous intraepithelial neoplasia or worse (bHSIL+), calculated among WLHIV in the Women's Interagency HIV Study, to 'risk benchmarks' for specific management strategies in the general population. Methods: We applied parametric survival models among 2423 WLHIV with negative or atypical squamous cell of undetermined significance (ASC-US) cytology during 2000'2015. Separately, we synthesized published general population bHSIL+ risks to generate 3-year risk benchmarks for a 3-year return (after negative cytology, i.e. 'rescreening threshold'), a 6'12-month return (after ASC-US), and immediate colposcopy [after low-grade squamous intraepithelial lesion (LSIL)]. Results: Average 3-year bHSIL+ risks among general population women ('risk benchmarks) were 0.69% for a 3-year return (after negative cytology), 8.8% for a 612-month return (after ASC-US), and 14.4% for colposcopy (after LSIL). Most CDC guidelines for WLHIV were supported by comparing risks in WLHIV to these benchmarks, including a 3-year return with CD4+ greater than 500 cells/ml and after either three negative cytology tests or a negative cytology/oncogenic human papillomavirus cotest (all 3-year risks≤1.3%); a 1-year return after negative cytology with either positive oncogenic human papillomavirus cotest (1-year risk=1.0%) or CD4+ cell count less than 500 cells/ml (1-year risk=1.1%); and a 612-month return after ASC-US (3-year risk=8.2% if CD4+ cell count at least 500 cells/ml; 10.4% if CD4+ cell count=350499 cells/μl). Other suggestions differed modestly from current guidelines, including colposcopy (vs. 612 month return) for WLHIV with ASC-US and CD4+ cell count less than 350 cells/μl (3-year risk=16.4%) and a lengthened 2-year (vs. 1-year) interval after negative cytology with CD4+ cell count at least 500 cells/ml (2-year risk=0.98%). Conclusions: Current cervical cancer screening guidelines for WLHIV are largely appropriate. CD4 cell count may inform risk-tailored strategies.",
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TY - JOUR

T1 - Cervical cancer screening intervals and management for women living with HIV

T2 - AIDS

AU - Robbins,Hilary A.

AU - Strickler,Howard D.

AU - Massad,L. Stewart

AU - Pierce,Christopher B.

AU - Darragh,Teresa M.

AU - Minkoff,Howard

AU - Keller,Marla J.

AU - Fischl,Margaret

AU - Palefsky,Joel

AU - Flowers,Lisa

AU - Rahangdale,Lisa

AU - Milam,Joel

AU - Shrestha,Sadeep

AU - Colie,Christine

AU - D'Souza,Gypsyamber

PY - 2017/4/24

Y1 - 2017/4/24

N2 - Objective: We suggested cervical cancer screening strategies for women living with HIV (WLHIV) by comparing their precancer risks to general population women, and then compared our suggestions with current Centers for Disease Control and Prevention (CDC) guidelines. Design: We compared risks of biopsy-confirmed cervical high-grade squamous intraepithelial neoplasia or worse (bHSIL+), calculated among WLHIV in the Women's Interagency HIV Study, to 'risk benchmarks' for specific management strategies in the general population. Methods: We applied parametric survival models among 2423 WLHIV with negative or atypical squamous cell of undetermined significance (ASC-US) cytology during 2000'2015. Separately, we synthesized published general population bHSIL+ risks to generate 3-year risk benchmarks for a 3-year return (after negative cytology, i.e. 'rescreening threshold'), a 6'12-month return (after ASC-US), and immediate colposcopy [after low-grade squamous intraepithelial lesion (LSIL)]. Results: Average 3-year bHSIL+ risks among general population women ('risk benchmarks) were 0.69% for a 3-year return (after negative cytology), 8.8% for a 612-month return (after ASC-US), and 14.4% for colposcopy (after LSIL). Most CDC guidelines for WLHIV were supported by comparing risks in WLHIV to these benchmarks, including a 3-year return with CD4+ greater than 500 cells/ml and after either three negative cytology tests or a negative cytology/oncogenic human papillomavirus cotest (all 3-year risks≤1.3%); a 1-year return after negative cytology with either positive oncogenic human papillomavirus cotest (1-year risk=1.0%) or CD4+ cell count less than 500 cells/ml (1-year risk=1.1%); and a 612-month return after ASC-US (3-year risk=8.2% if CD4+ cell count at least 500 cells/ml; 10.4% if CD4+ cell count=350499 cells/μl). Other suggestions differed modestly from current guidelines, including colposcopy (vs. 612 month return) for WLHIV with ASC-US and CD4+ cell count less than 350 cells/μl (3-year risk=16.4%) and a lengthened 2-year (vs. 1-year) interval after negative cytology with CD4+ cell count at least 500 cells/ml (2-year risk=0.98%). Conclusions: Current cervical cancer screening guidelines for WLHIV are largely appropriate. CD4 cell count may inform risk-tailored strategies.

AB - Objective: We suggested cervical cancer screening strategies for women living with HIV (WLHIV) by comparing their precancer risks to general population women, and then compared our suggestions with current Centers for Disease Control and Prevention (CDC) guidelines. Design: We compared risks of biopsy-confirmed cervical high-grade squamous intraepithelial neoplasia or worse (bHSIL+), calculated among WLHIV in the Women's Interagency HIV Study, to 'risk benchmarks' for specific management strategies in the general population. Methods: We applied parametric survival models among 2423 WLHIV with negative or atypical squamous cell of undetermined significance (ASC-US) cytology during 2000'2015. Separately, we synthesized published general population bHSIL+ risks to generate 3-year risk benchmarks for a 3-year return (after negative cytology, i.e. 'rescreening threshold'), a 6'12-month return (after ASC-US), and immediate colposcopy [after low-grade squamous intraepithelial lesion (LSIL)]. Results: Average 3-year bHSIL+ risks among general population women ('risk benchmarks) were 0.69% for a 3-year return (after negative cytology), 8.8% for a 612-month return (after ASC-US), and 14.4% for colposcopy (after LSIL). Most CDC guidelines for WLHIV were supported by comparing risks in WLHIV to these benchmarks, including a 3-year return with CD4+ greater than 500 cells/ml and after either three negative cytology tests or a negative cytology/oncogenic human papillomavirus cotest (all 3-year risks≤1.3%); a 1-year return after negative cytology with either positive oncogenic human papillomavirus cotest (1-year risk=1.0%) or CD4+ cell count less than 500 cells/ml (1-year risk=1.1%); and a 612-month return after ASC-US (3-year risk=8.2% if CD4+ cell count at least 500 cells/ml; 10.4% if CD4+ cell count=350499 cells/μl). Other suggestions differed modestly from current guidelines, including colposcopy (vs. 612 month return) for WLHIV with ASC-US and CD4+ cell count less than 350 cells/μl (3-year risk=16.4%) and a lengthened 2-year (vs. 1-year) interval after negative cytology with CD4+ cell count at least 500 cells/ml (2-year risk=0.98%). Conclusions: Current cervical cancer screening guidelines for WLHIV are largely appropriate. CD4 cell count may inform risk-tailored strategies.

KW - Benchmarking

KW - CD4

KW - Cervical cancer

KW - Cervical intraepithelial neoplasia

KW - High-grade squamous intraepithelial neoplasia

KW - HIV

KW - Precancer

KW - Risk

KW - Screening guidelines

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