When is a Papanicolaou test indicated in the management of HIV infection in primary care?

Updated: Apr 09, 2019
  • Author: Jason F Okulicz, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Cervical cancer screening in women: If a cervical Papanicolaou test yields normal findings, repeat after 6 months and then annually thereafter. If the findings are abnormal, further evaluation should be performed as indicated.

Anal cancer screening: HIV-infected men and women with human papillomavirus (HPV) infection are at increased risk for anal dysplasia and cancer, particularly men who have sex with men (MSM). Anal cancer is the fourth most common cause of cancer in patients with HIV infection or AIDS. [15, 15] Anal cytologic screening (anal Papanicolaou test) is recommended in MSM, women with a history of receptive anal intercourse or abnormal cervical Papanicolaou test results, and all HIV-infected persons with genital warts. [10]

Anal cytology is a reasonable predictor of anal intraepithelial neoplasia (AIN), but there is poor correlation between cytology and histologic grade. [15] Unfortunately, no randomized controlled trials have documented the value of AIN screening to date. Thus, the recommendation to perform anal Papanicolaou tests relies mostly on the histologic similarity between the cervix and the anus and the significant benefits of cervical cytology screening in reducing the incidence of cervical cancer.

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