Gynecological conditions and HIV / AIDS

October 2005     View PDF     En español

Screening

Since women with HIV have high rates and generally more severe cases of GYN conditions, it’s important to get frequent and regular screening.

Pap smear
A Pap smear is a standard part of the routine GYN exam. This is a test in which a doctor will collect cells from your cervix. A Pap smear can detect any inflammation, and in most cases predict abnormalities in cervical cells. For women living with HIV, if your CD4+ cell count is below 300 or has been dropping, it is suggested that you have a Pap smear every six months. If you have an abnormal Pap smear, further evaluation with a colposcopy is suggested.

The Pap smear usually may cause a sensation that feels like pressure on the cervix. However, when there is tenderness or swelling, even a Pap smear can cause pain and discomfort. While the Pap smear is fairly non-invasive, some experts are beginning to question its usefulness. This is especially true when it’s used to screen for cervical cancer in women with HIV.

The problem with Pap smears is that 15–30% of the results that come back as “normal” are, upon doing further tests, actually abnormal. These are called false-negative results. In other words, abnormal cell growth that may need further examination or immediate treatment may pass undetected. This problem has led some healthcare providers to suggest colposcopy as a more accurate procedure, especially for HIV-positive women when early detection of GYN problems is critical.

Reading the Pap Smear Results
There are two methods that have been used to read the results from Pap smears. Most labs use the Bethesda System. Results are divided into categories based on the changes in the size and shape of the cells. Some labs may use another system to report the results called the Cervical Intraepithelial Neoplasia (CIN) System. In this system the degree of cell abnormality is assigned a number. Below is a chart explaining what the results for the Bethesda and CIN Systems mean.

Colposcopy
A solution of diluted vinegar is applied to the cervix/anus to remove the mucus and highlight the abnormal cells. Using a light and a microscope (called a colposcope, or anoscope if they’re looking at anal tissue), the doctor can look at the tissue closely. The vinegar makes the abnormal cells white and the normal cells appear pink. Lesions, warts and inflammation are usually visible during the colposcopy, however it is difficult to determine if the changes are mild or severe. If abnormal cells are seen a biopsy is usually done.

This procedure may cause discomfort, however, it usually isn’t painful. A colposcopy needs to be done by a specialist. It may also be done with a biopsy, there is a risk of infection and bleeding.

Biopsy
A biopsy is when a small amount of tissue is taken from the area where abnormal cells are found. A biopsy can tell the difference between a mild lesion and a severe lesion. A biopsy can be uncomfortable and painful. Some women experience mild bleeding after the procedure.

Standard GYN Screening for Women
Exam Result Follow-up
Pap smear Normal Pap every 12 months
Pap smear Inflammation Pap every 3 months
Pap smear Abnormal cells (dysplasia) Colposcopy, biopsy; Pap every 3 months

NOTE: For women with symptomatic HIV infection and/or a CD4+ cell count below 200, a Pap smear is suggested every 6 months.

Bethesda System CIN System What does this mean?
Negative for Squamous Intraepithelial Lesions or Dysplasia Not Applicable There are no abnormal cell changes detected.
Atypical (unusual) Squamous Cells of Undetermined Significance (ASCUS)

ASC-H is a new category added which means atypical squamous cells and high-grade lesions cannot be ruled out. Atypia There may be inflammation in the cervix; however, it cannot be determined if the cells are normal or abnormal. Suggest follow-up with a colposcopy.
Low Grade Squamous Intraepithelial Lesions (LGSIL) CIN I Mild cell abnormalities (dysplasia) are present on the surface of the cervix. For women living with HIV, treatment is not considered standard; however, careful monitoring is strongly suggested.
High Grade Squamous Intraepithelial Lesions (HGSIL) CIN II/
CIN III Moderate to severe dysplasia and/or precancerous lesions. Treatment is recommended.