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Study confirms recommendations for frequency of cervical cancer screening in HIV-infected women

Women infected with HIV have a greater risk than other women of developing cervical cancer and other cervical diseases. The prevalence of cervical dysplasia (abnormal cells) in these women ranges from 11 to 60 percent, depending on how severely suppressed their immune system is. A recent study recommends that all HIV-infected women, regardless of their CD4 cell count (a measure of immune system function), have two Pap smears 6 months apart to screen for cervical cancer and annual Pap smears thereafter, if the initial Pap results are normal. This is in line with the current recommendation of the Centers for Disease Control and Prevention (CDC).

The study was supported by the Agency for Health Care Policy and Research (HS07317 and National Research Service Award training grant T32 HS00020) and conducted by researchers at Harvard University, Boston Medical Center, and Boston University's Schools of Medicine and Public Health. They developed a model to simulate cervical cancer screening, diagnosis, and treatment in hypothetical groups of HIV-infected women in order to estimate the clinical benefits, costs, and cost-effectiveness of six screening strategies for cervical neoplasia (new cell growth) and cancer in HIV-infected women.

The estimates showed that annual Pap smear screening resulted in a 2.1 month gain in quality-adjusted life expectancy for an incremental cost of $12,800 per quality-adjusted-life-year (QALY) saved. The strategy recommended by the CDC and the authors of this paper provided an additional 0.04 QALY at a cost of $14,800 per QALY saved, a benefit that is similar to other clinical interventions. Routine semiannual Pap smears provided a further 0.17 QALY but at a cost of $27,600 per QALY saved. Annual colposcopy examination cost more but provided no additional benefit compared with semiannual Pap smears. The cost of semiannual colposcopy exceeded $375,000 per QALY saved.

See "The costs, clinical benefits, and cost-effectiveness of screening for cervical cancer in HIV-infected women," by Sue J. Goldie, M.D., M.P.H., Milton C. Weinstein, Ph.D., Karen M. Kuntz, Sc.D., and Kenneth A. Freedberg, M.D., M.Sc., in the January 19, 1999, Annals of Internal Medicine 130, pp. 97-107.

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