Cervical Glandular Changes on Pap Tests Linked to HIV Infection

Cytologic glandular abnormalities on Pap tests in women with HIV have not been studied thoroughly. Researchers followed 2791 HIV-seropositive and 975 at-risk seronegative women who underwent Pap smears every 6 months from 1994 through 2007. Results for HIV-positive women were stratified by CD4 lymphocyte count. Glandular abnormalities were classified as atypical glandular cells, adenocarcinoma in situ, and adenocarcinoma.

Glandular abnormalities were present in 1.0% of Pap tests among HIV-positive women with CD4 lymphocyte counts lower than 250/mm3, 0.8% of tests in women with counts from 250 to 500/mm3, 0.6% of tests in women with counts higher than 500/mm3, and 0.6% of tests in HIV-negative women (P for trend, 0.006). Only 61% of women with glandular abnormalities underwent documented colposcopies within 6 months, and only 38% underwent cervical biopsies. The authors speculate that low colposcopy rates might have resulted from patient nonadherence or from clinicians not recommending colposcopy.

Comment: Women with HIV have excess risk for squamous cervical intraepithelial lesions and squamous carcinomas. These results reinforce that cervical glandular changes are also linked to HIV infection and clearly demonstrate that lower CD4 counts are correlated with higher risk for such changes. Women with HIV are at excess risk for missing colposcopy appointments, and the burden of HIV affects underserved women disproportionately.

Therefore, clinicians should take care that all women — but especially HIV-positive women — are informed of Pap test results and have access and support to undergo follow-up procedures. The American Society for Colposcopy and Cervical Pathology recommends colposcopies and endocervical and endometrial biopsies in women with glandular abnormalities on Pap smears

Are Cervical Glandular Changes on Pap Tests Linked to HIV Infection?