Human Papillomavirus Infection
Prevention of Exposure
HIV-infected persons should use latex condoms during every act of sexual
intercourse to reduce the risk of exposure to human papillomavirus (HPV)
as well as to other sexually transmitted pathogens.
Prevention of Disease
HPV-associated Genital Epithelial Cancers in HIV-infected Women
After a complete history of previous cervical disease has been obtained,
HIV-infected women should have a pelvic examination and a Pap smear. In
accordance with the recommendation of the Agency for Health Care Policy and
Research, the Pap smear should be obtained twice in the first year after diagnosis
of HIV infection and, if the results are normal, annually thereafter.
If the results of the Pap smear are abnormal, care should be provided according to the Interim Guidelines for Management of Abnormal Cervical Cytology published by a National Cancer Institute Consensus Panel (19) and briefly summarized below.
For patients whose Pap smears are interpreted as atypical squamous cells of undetermined significance (ASCUS), several management options are available; the choice depends in part on whether the interpretation of ASCUS is qualified by a statement indicating that a neoplastic process is favored. Follow-up by Pap tests without colposcopy is acceptable, particularly when the diagnosis of ASCUS is not qualified further or the cytopathologist favors a reactive process. In such situations, Pap tests should be repeated every 46 months for 2 years until three consecutive smears have been negative. If a second report of ASCUS occurs in the 2-year follow-up period, the patient should be considered for colposcopic evaluation. Women who have a diagnosis of unqualified ASCUS associated with severe inflammation should be evaluated for an infectious process. If specific infections are identified, reevaluation should be performed after appropriate treatment, preferably after 23 months. If the diagnosis of ASCUS is qualified by a statement indicating that a neoplastic process is favored, the patient should be managed as if a low-grade squamous intraepithelial lesion (LSIL) were present (see note [5]). If a patient who has a diagnosis of ASCUS is at high risk (i.e., previous positive Pap tests or poor compliance with follow-up), the option of colposcopy should be considered.
Several management options are available for patients who have LSIL. Follow-up with Pap tests every 46 months is used by many clinicians and is currently used in countries outside the United States as an established method of management. Patients managed in this fashion must be carefully selected and considered reliable for follow-up. If repeat smears show persistent abnormalities, colposcopy and directed biopsy are indicated (BIII). Colposcopy and directed biopsy of any abnormal area on the ectocervix constitute another appropriate option.
Women who have cytologic diagnosis of high-grade squamous intraepithelial lesions (HSIL) or squamous cell carcinoma should undergo colposcopy and directed biopsy (AII).
HPV-associated Anal Intraepithelial Neoplasia and Anal Cancer in HIV-infected
Men Who Have Sex With Men
Although the risks for anal intraepithelial neoplasia (AIN) and anal
cancer are increased among HIV-infected men who have sex with men, the role
of anal cytologic screening and treatment of AIN in preventing anal cancer
in these men is not well defined. Therefore, no recommendations can be made
for periodic anal cytologic screening for the detection and treatment of
AIN.
Prevention of Recurrence
The risks for recurrence of squamous intraepithelial lesions and cervical
cancer after conventional therapy are increased among HIV-infected women.
The prevention of illness associated with recurrence depends on careful follow-up
of patients after treatment. Patients should be monitored with frequent cytologic
screening and, when indicated, with colposcopic examination for recurrent
lesions.
Go to the Disease-Specific Recommendations Menu
Go to the USPHS/IDSA Guidelines Menu
Go to the Opportunistic Infections Menu
Go to the HIVpositive.us Main Menu