Women infected with HIV are living longer due to the widespread use of antiretroviral therapy. Early initiation of ART reduces the risk of cancer and infection-associated cancers in particular. However, HIV-infected women remain at increased risk of cervical cancer, especially those living in resource-constrained settings. HPV testing plays a key role in cervical cancer screening for HIV-uninfected women, but the utility in HIV-infected has remained unclear.
This presentation will review trial and cohort data of cervical cancer screening testing among HIV-infected women. The role of HPV testing and alternative biomarkers for determining risk of cervical HSIL will be examined. We will review recent changes to cervical cancer screening guidelines for HIV-infected women.
High risk HPV testing, in particular HPV 16, predicts the risk of cervical HSIL in HIV-infected and HIV-uninfected settings. HPV testing can be used in HIV-infected women using similar algorithms as for HIV-uninfected women. HPV-based screen and treat approaches hold promise for HIV-infected women in resource-constrained settings. The types and quantity of HPV DNA may improve the specificity for cervical HSIL in such approaches.
In resource-rich settings, recommendations for cervical cancer screening are now similar for HIV-infected and uninfected women. HPV testing can be used to determine the risk of cervical HSIL. Availability of rapid, near point-of-care HPV testing may allow for dissemination of HPV-based screen-and-treat approaches for HIV-infected women in resource-constrained settings. New biomarkers hold promise for further improvements of cervical cancer prevention strategies.