Cervical and Anal Cytology Screening in HIV-Positive Women Over Age 65 [10F]

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Abstract

INTRODUCTION:

HIV-positive women over age 65 are a growing population due to improved survival with anti-retroviral treatment. HIV-positive women are at higher risk of cervical and anal cancer. Screening guidelines in this age group are lacking. Our objective is to assess cervical and anal cytology screening in this cohort.

METHODS:

We performed a retrospective review of 75 HIV-positive women over age 65. Demographics, co-morbidities, smoking, cervical and anal cytology, sexually transmitted infections (STI), immune markers, anti-retroviral use, and preventive screening were collected.

RESULTS:

Mean age was 72 (±5). 52 (69%) identified as Black; 22 (29%) Hispanic. Mean age of HIV diagnosis was 58 (±7); average age of menopause was 46 (±7.7). 69 (92%) were on antiretroviral medications and the majority had undetectable viral loads. 54 (80%) had a STI; 17 (23%) smoked. Baseline cervical cytology: 55% normal, 31% ASCUS, 12% LSIL, and 2% ASC-H/HSIL. There were no cases of cervical or anal cancer. 4 had LEEP/cone biopsy; all had normal follow-up cytology. 31 women had anal cancer screening yielding 87% abnormal results. 96% had mammograms, 37% had colonoscopies and 41% had screening for osteoporosis. Many women had comorbidities including hypertension (80%) and diabetes (28%).

CONCLUSION:

The vast majority of HIV-positive women over age 65 had normal or low-grade cervical screening and none had cervical or anal cancer. Notably, of the few high-grade lesions, none progressed after LEEP/cone biopsy. Co-morbidities and STIs were common and may affect outcomes. Future studies can determine if serial pap smears are needed in this population with initial negative screens.

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