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British HIV Association/British Association for Sexual Health and HIV (BHIVA/BASHH) guidelines recommend annual cervical cytology for HIV-positive women but do not specify the age at which screening should start, although they do recognise that there may be a role for surveillance in women younger than 25 years.1 The National Cervical Screening Programme (NCSP) recommends screening of the general population from 25 years of age—a policy introduced in 2004.2 Prior to this, all women were offered screening from the age of 20. Current NCSP guidance suggests that the screening age should be the same for both HIV-positive and HIV-negative women.
In April 2009, we conducted an email and postal questionnaire among Genitourinary Medicine Consultants in the Trent, Yorkshire and Humber regions to determine their current practice regarding cervical cytology in HIV-infected women aged <25 and to explore practitioners' views on screening in this group.
Of the 40 consultants, 34 (87%) responded to the survey; 52.9% (18 of 34) currently only offered cytology testing from the age of 25; 14.7% (5 of 34) offered annual testing from the onset of sexual activity and 17.6% (6 of 34) started testing from 20 years if sexually active. The remainder tested only in selected cases or used other models.
When considering preferred screening options, only 38% of consultants would choose to delay initiating screening until the age of 25; 41.2% would prefer to start annual screening either from 20 years if sexually active or from the age of first sexual contact.
HIV-positive women are at greater risk of cervical cancer and have higher rates of cervical intraepithelial neoplasia (CIN) even with mild 3 cytological atypia. Spontaneous regression of CIN is also less likely and rates of progression are higher if women are significantly immunosupressed.3 4 It is therefore questionable whether the benefits of delaying screening to the age of 25 seen in the general population are transferable and applicable to HIV-infected women. It would appear clinicians have ongoing concerns that these risks have not been fully evaluated. Until such evidence is available, we believe that clinicians should retain the right to offer cytology testing for HIV-positive women under 25 years if they feel this is in their patients' best interests. Unfortunately, this is not always the case, and in some areas the practice is restricted by local cytology testing policy.
The authors thank Drs David Kellock and Amy Mammen Tobin for their assistance in identifying consultants within Trent, Yorkshire and Humber and all those who participated in the survey.
Competing interests None.
Provenance and peer review Not commissioned; not externally peer reviewed.
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