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Prevalence of Cervical Cancer Screening of HIV-Infected Women in the United States

Oster, Alexandra M MD*†; Sullivan, Patrick S DVM, PhD†‡; Blair, Janet M PhD, MPH

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 2009 - Volume 51 - Issue 4 - p 430-436
doi: 10.1097/QAI.0b013e3181acb64a
Clinical Science

Background: HIV-infected women are at increased risk of cervical cytologic abnormalities. HIV treatment guidelines recommend annual Papanicolaou (Pap) tests for HIV-infected women. We assessed screening prevalence and associated factors among HIV-infected women.

Methods: We used data collected during 2000-2004 in an interview study of HIV-infected persons in 18 states. We performed logistic regression to describe factors associated with not having an annual Pap test.

Results: Of 2417 women, 556 (23.0%) did not report receiving a Pap test during the past year. Not having a Pap test was associated with increasing age [adjusted odds ratio (AOR) = 1.3 per 10 years, 95% confidence interval (CI): 1.1 to 1.4] and most recent CD4 count of <200 cells per microliter (AOR = 1.6, CI: 1.1 to 2.1) or unknown (AOR = 1.4, CI: 1.1 to 1.7; both vs. CD4 count of ≥200 cells/μL). Odds of a missed Pap test increased for women whose most recent pelvic exam was not performed at their usual source of HIV care (AOR = 2.6, CI: 2.1 to 3.2).

Conclusions: Nearly 1 in 4 women did not receive an annual Pap test. HIV care providers should ensure that HIV-infected women receive annual Pap tests, recognizing that missed Pap tests are more likely among older women and women with low CD4 cell counts. Integrating HIV and gynecologic care and educating clinicians about recommendations may increase screening.

From the *Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA; †Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and ‡Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.

Received for publication August 27, 2008; accepted February 17, 2009.

Project areas were funded through cooperative agreement with the Centers for Disease Control and Prevention.

Portions of these data were presented at the Epidemic Intelligence Service Conference, April 18, 2008, Atlanta, GA and at the Conference on Retroviruses and Opportunistic Infections, February 10, 2009, Montreal, Canada.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Correspondence to: Alexandra M. Oster, MD, 1600 Clifton Road NE, MS E-46, Atlanta, GA 30333 (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.