Cervical cancer is the 4th most frequent cancer in women worldwide. It is known that women with HIV have increased risk of high grade cervical squamous intra-epithelial lesions and invasive cervical cancer. The incidence of invasive cervical cancer did not decrease with arrival of antiretroviral therapy in this population. Current guidelines for cervical cancer screening (CCS) recommend that HIV+ women should have CCS on initiation of care and repeated at 6 months and annually and thereafter, if results are normal. Cytology based approach requires frequent monitoring; we wanted to evaluate compliance with CCS guidelines.
We conducted a retrospective review of all HIV+ females 18 years and older actively enrolled in a Central Texas Clinic from 1997 until June 2014. Women enrolled after June 2014 were excluded in order to provide time to capture patients that fulfill the guidelines. We reviewed the electronic medical records for CCS, by reviewing pathology results. Results were categorized into time intervals of less than 1 year, 1-5 years and greater than 5 years.
1783 HIV+ patients were enrolled in the clinic from 1998 until June 2014. 193 women were included after excluding inactive, deceased, recently established, and male patients. 90(62%) had CCS within 1 year of establishment of care.
Of the 193 HIV+ females 140(72%) had initial CCS, 48(34%) were abnormal of which 9(19%) had no repeats. 92(76%) had initial negative screening for intraepithelial lesions and 28(30%) had no repeat CCS done. 64(70%) females with negative CCS had repeat CCS but only 14(22%) were done within the first year, 44(69%) were done between 1-5 years and 6(9%) were done greater than 5. 53(27%) patients had no CCS documented of which 18 had hysterectomies.
In this study we reviewed CCS in HIV+ females enrolled in a Central Texas Clinic in the last 17 years. We found that only 14% of patients had CCS that met guideline recommendations. Furthermore, we found that 18% of eligible, actively enrolled females have not undergone any CCS. Further research is needed to increase compliance and improve quality of care.