Hematology/Oncology Clinical Practice Guidelines: 2018 Midyear Review

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO

Disclosures

July 09, 2018

In This Article

Cervical Cancer Screening in HIV Patients

New York State Department of Health (NYSDOH) AIDS Institute Medical Care Criteria Committee

Offer all individuals with HIV, aged 9 to 26 years, the 9-valent human papillomavirus (HPV) vaccine 3-dose regimen regardless of previous Pap test results or CD4 cell count.

A history of HPV-related cervical cytologic changes should not exclude individuals from being vaccinated.

Available data do not support HPV vaccination in all adults older than 26 years, including those with HIV.

Eligible for screening include all people with HIV who have a cervix and/or vagina, including cisgender women (individuals assigned female at birth who identify as female), transgender men (individuals assigned female at birth but who identify as male), and nonbinary individuals who were assigned female at birth but who identify as neither male nor female.

Vaginal screening is reserved for those who have had a total hysterectomy and have a history of abnormal cervical screening.

The guideline strongly encourages care providers to ask patients about any previous history of cervical abnormalities and about gender-reassignment and gynecologic surgeries to determine whether a patient needs cervical or vaginal screening.

Because the source of most cervical dysplasia is genital HPV, a sexually transmitted infection, the Committee does not recommend Pap tests before sexual debut.

The Pap test is useful for identifying patients who need further evaluation, which may include HPV testing, more frequent Pap tests, referral for colposcopy with directed biopsy, and treatment of biopsy-proven histologic abnormalities.

HPV co-testing (a cervical cytologic test with a concurrent HPV test) is routinely performed in persons aged 30 years or older. HPV testing in response to an abnormal cervical Pap test result (HPV reflex testing) is performed in persons younger than age 30 years with a Pap test that shows atypical squamous cells (ASCs) of undetermined significance (ASC-US) or above, or a persistent ASC-US Pap, and in persons aged 30 years or older who did not receive an HPV co-test at the time of their cervical Pap test.

A diagnosis of high-risk HPV infection requires follow-up with colposcopy. In addition, colposcopy should be performed in response to the following Pap test results: persistent ASCs, high-grade squamous intraepithelial lesion (HSIL) cannot be excluded; low-grade squamous intraepithelial lesion; HSIL; and any result of atypical glandular cells.

HPV testing as a primary screening test without cytologic screening is not recommended for persons with HIV.

The diagnostic standard for cervical dysplasia is a histologic specimen, which is obtained through colposcopy-directed biopsy. Colposcopy should not be used as a primary screening method. Persons who require colposcopy are identified through the screening Pap test. Random biopsies are not useful for cervical dysplasia diagnosis. Colposcopy should be performed by an experienced clinician.

Reference

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