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Abnormal Pap Tests and Human Papillomavirus Infections Among HIV-Infected and Uninfected Women Who Have Sex With Women

Massad, L. Stewart MD1; Xie, Xianhong PhD2; Minkoff, Howard MD3; Darragh, Teresa M. MD4; D’Souza, Gypsyamber PhD5; Sanchez-Keeland, Lorraine PA-C6; Watts, D. Heather MD7; Colie, Christine MD8; Strickler, Howard D. MD, MPH2

Journal of Lower Genital Tract Disease: January 2014 - Volume 18 - Issue 1 - p 50–56
doi: 10.1097/LGT.0b013e3182942733
Original Articles

Objective To estimate the frequency of abnormal Pap and human papillomavirus (HPV) positivity among human immunodeficiency virus (HIV)–seropositive and –seronegative women who have sex with women (WSW).

Methods Pap and HPV DNA polymerase chain reaction tests were obtained every 6 months from women in a US cohort of HIV-seropositive and -seronegative women. Women who have sex with women were women reporting no male and at least 1 female sex partner for 5 years. They were frequency matched 1:5 to women reporting sex only with men (WSM) and assessed using multivariable generalized estimating equation logistic regression models.

Results Paps at study entry were abnormal in 12 (21%) of 49 HIV-seropositive WSW, 151 (64%) of 245 HIV-seropositive WSM, 3 (9%) of 24 HIV-seronegative WSW, and 16 (11%) of 120 HIV-seronegative WSM. Human papillomavirus was found at entry in 18 (42%) HIV-seropositive WSW, 109 (52%) HIV-seropositive WSM, 6 (27%) HIV-seronegative WSW, and 13 (13%) HIV-seronegative WSM. After controlling for HIV serostatus and CD4 count, WSW had marginally lower odds than WSM of Pap abnormality (odds ratio = 0.59, 95% confidence interval = 0.33–1.03) and of HPV (odds ratio = 0.53, 95% confidence interval = 0.32–0.89). After controlling for partner’s gender, HIV seropositivity and lower CD4 count were associated with any HPV, oncogenic HPV, any abnormal Pap result, and high-grade squamous intraepithelial lesion or worse (p < .0001 for all).

Conclusions Although risks for abnormal Pap and HPV are modestly lower in WSW than in WSM, both are common in HIV-seropositive women regardless of sexual preference. Both WSW and WSM should be screened similarly.

Similar rates of human papillomavirus infection and abnormal Paps between women who have sex with women and those who have sex with men mean screening should be similar.

1Washington University School of Medicine, St. Louis, MO; 2Albert Einstein College of Medicine, Bronx, NY; 3Maimonides Medical Center, Brooklyn, NY; 4University of California, San Francisco, CA; 5Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; 6University of Southern California, Los Angeles, CA; 7Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; and 8Georgetown University, Washington, DC

Reprint requests to: L. Stewart Massad, MD, Washington University School of Medicine, St. Louis, MO. E-mail:

The authors have declared they have no conflicts of interest.

Major support for this study, including HPV DNA testing, was provided through R01-CA-085178 (H.S.).

Data in the article were collected by the Women’s Interagency HIV Study (WIHS) Collaborative Study Group with centers (Principal Investigators) at New York City/Bronx Consortium (Kathryn Anastos); Brooklyn, NY (Howard Minkoff); Washington DC Metropolitan Consortium (Mary Young); The Connie Wofsy Study Consortium of Northern California (Ruth Greenblatt); Los Angeles County/Southern California Consortium (Alexandra Levine); Chicago Consortium (Mardge Cohen); Data Coordinating Center (Stephen Gange). The WIHS is funded by the National Institute of Allergy and Infectious Diseases (UO1-AI-35004, UO1-AI-31834, UO1-AI-34994, UO1-AI-34989, UO1-AI-34993, and UO1-AI-42590) and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (UO1-HD-32632). The study is cofunded by the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute on Deafness and Other Communication Disorders. Funding is also provided by the National Center for Research Resources (UCSF-CTSI Grant Number UL1 RR024131).

The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology