Current guidelines for HIV-uninfected women do not advocate for continued vaginal pap smears for screening of vaginal intraepithelial neoplasia (VAIN) and vaginal cancer post-hysterectomy. Little data exists to propose the same guidelines for HIV-infected women that maybe at an increased risk. Our objective was to evaluate the prevalence of VAIN or vaginal cancer in HIV infected women with no history of abnormal cytologic screening who had hysterectomy for conditions other than cervical dysplasia/cancer. Secondarily, we sought to explore the risk factors associated with VAIN or vaginal cancer in these women.
A retrospective cohort study was performed identifying 238 women between 01/2014 to 01/2015 with a history of HIV, previous hysterectomy and no previous abnormal pap smears.
From 238 women, 12 (5%) had ASCUS/HPV+ pap smears, 55 (23.1%) had LSIL pap smears, and 7 (2.9%) had HSIL pap smears. No progression to vaginal cancer was found. No specific risk factor was associated with progression to vaginal dysplasia after hysterectomy. Of those who underwent vaginal biopsies for an abnormal pap smear, 15 (28%) were normal, 23 (43%) were VAIN1, 9 (16%) were VAIN2, and 7 (13%) were VAIN3. No patients had invasive vaginal cancer. Of note, patients had more time to abnormal pap with increased CD4 count (P=.0234) or with decreased log of viral load (P=.005).
Over 30% of HIV-infected women who had no pre-hysterectomy history of an abnormal Pap had abnormal Pap tests. Among those who had vaginal biopsies 28% had VAIN2 or VAIN3, suggesting that pap smears post hysterectomy in the HIV population may be indicated.
Baylor COM, Houston, TX
Financial Disclosure: The authors did not report any potential conflicts of interest.