Frequency of high grade squamous cervical lesions among women over age 65 years living with the human immunodeficiency virus.

Abstract

BACKGROUND\nCurrent U.S. cervical cancer screening guidelines recommend a stop to screening at age 65 years provided women have adequate prior screening and no history of precancer. Women living with the human immunodeficiency virus (HIV) are at higher risk for cervical cancer than uninfected women, but data a few to quantify risk among women who otherwise would qualify for screening cessation OBJECTIVE: To determine whether guidelines recommending women stop cervical cancer screening at 65 years are appropriate for women living with the human immunodeficiency virus (HIV).\n\n\nSTUDY DESIGN\nSemiannual Pap testing was done as part of surveillance visits in the Women s Interagency HIV Study (WIHS). WIHS is the federally funded U.S. multisite cohort study that has enrolled 3678 women living with HIV and 1304 HIV-negative women that launched in October, 1994; we included data through September, 2019. Conventional Pap smears were collected at scheduled six-month visits and read centrally according to 1991 Bethesda System criteria. Results were analyzed among women at least 65 years of age. The primary endpoint was high grade cytology, including high grade squamous intraepithelial lesion, atypical glandular cells, atypical squamous cells cannot exclude high grade lesion, and malignant cytology. Wilcoxon rank-sum tests were used to compare the continuous variables, and Chi-square tests or Fisher s exact tests were used to compare the categorical variables. The Kaplan-Meier method was used to calculate the cumulative incidence. Poisson regression was used to compare two incidence rates.\n\n\nRESULTS\nOf 169 eligible women (121 women living with HIV, 48 HIV negative) who contributed 678.4 woman-years of observation after reaching age 65 years, 2.2% had high grade cytologic abnormalities. No cancers were found. Twenty women had prior precancer and 74 had abnormal Pap results in the prior decade. Among 50 women (38 women living with HIV and 12 HIV negative) with prior hysterectomy and no history of cervical precancer, the cumulative incidence of HSIL was 0.6 (95% C.I 0.0, 3.2)/100 woman-years for WLWH, and 0.0 (0.0, 8.1)/100 woman-years for HIV- patients (p = 0.61).Only 48 women (27 women living with HIV, 21 HIV negative) had cervices and met current guidelines to stop screening; their risk of a high grade squamous intraepithelial lesion was 2.2 (95% C.I. 0.6, 5.5)/100 woman-years overall and did not vary by HIV status (2.3, 95% C.I. 0.5, 6.8 for women living with HIV and 1.8, 95% C.I. 0.0, 9.8/100 woman years, p = 0.81).\n\n\nCONCLUSION\nMost women living with HIV do not meet criteria for stopping cervical cancer screening and will need to continue beyond 65 years of age, but women who meet criteria for screening cessation have risks for high grade squamous lesions similar to those of HIV negative women and may elect to stop.