Use of VIA, Pad smear or HR-HPV testing in women living with HIV/AIDS for post-treatment screening: same tests, different priorities

Abstract

Objectives

Few studies have addressed optimal follow-up for HIV-infected women after cervical treatment. This study aimed to compare performance of three available tests to detect post-treatment cervical disease in HIV-infected women in Kenya. Design

This is a prospective cohort study. Methods

At least six months following cryotherapy, 517 HIV-infected women were evaluated concurrently with VIA, Pap smear, and HR-HPV testing. Women positive by any test (≥LSIL for Pap) were scheduled for colposcopy and biopsy. Among 248 with histological confirmation (and 174 assumed to be truly negative for CIN2+ after testing negative by all three tests), the ability of each test alone, or in combination, to detect CIN2+ was calculated to determine their utility in post-treatment follow-up. Results

The median age of women was 35 years, 68% were WHO stage 1–2, with a median CD4 count of 410 cells/uL, and 87% were on combination antiretroviral therapy. At a median of 6.3 months post-treatment, 64% had an abnormal screen by VIA, Pap, and/or HR-HPV. Among women with histological confirmation, 72 (30%) had persistent/recurrent CIN2+. As single tests, Pap correctly classified the most cases (83%) and had the highest specificity (91% (88%, 95%); sensitivity 44% (35, 53%)), whereas HR-HPV had the highest sensitivity (85% (75%, 96%); specificity 54% (49%, 58%)). VIA was not sensitive (27% (18%, 36%)) for the detection of post-treatment CIN2+ (specificity 82% (79%, 86%)). Conclusions

With the goal to minimize the number of false negatives (e.g. not miss CIN2+ post-treatment) in this population that is high-risk due to both prior cervical disease and HIV infection, HR-HPV based algorithms are recommended.