Role of PAP Smear in Detection of Cytological Abnormalities of Uterine Cervix in HIV infected Women.

HIV/AIDS pandemic is emerging as one of the most serious health problems of this century and the focus is shifting fast from developed nations to developing countries including India due to its vast population1. In India, around 22% of total reported AIDS cases and 30% of newer HIV infections are among women. HIV infection results in progressive depletion of immune system making the host susceptible to various opportunistic infections and other AIDS related malignancies. Though the process cannot be stopped, it can be slowed down, which would improve the quality of life. Vulvo vaginal candidiasis , Cervical dysplasia ,Cervical cancer in situ and Pelvic inflammatory disease(PID) were added to the revised classification system of HIV infection under category B. Also cervical cancer has an increased occurrence and aggressiveness in HIV infected women. In 1993, The Center for Disease Control and Prevention (CDC) added Cervical Cancer to the list of AIDS defining malignancies. It is very important for the HIV - positive women to have regular Pap smear. Pap smear is one of the important screening procedures which was introduced by Dr George Papanicolaou and Traut in 1943 to lower the morbidity and mortality of cervical cancer by its early detection. An abnormal pap smear can indicate inflammation, infection, dysplasia or cancer. HIV infected women are 10 times more likely to have abnormal pap smears than HIV negative women. Hence CDC recommends, all HIV positive women should have a complete gynecological examination, including a pap smear, when they are first diagnosed or when they first seek prenatal care. Unlike most other cancers, Carcinoma Cervix is highly preventable when precursor lesions are detected and treated before they develop into cancer. This study is undertaken to mainly highlight the importance of cervical cytology in HIV positive women and to increase the awareness about the value of Pap smear as an integral part of preventive care for HIV infected women. Reproductive tract morbidities are common in HIV infected women. Hence, all HIV positive women must be screened periodically by Pap smear for evidence of genital tract involvement, so that they can be promptly and effectively treated. • Incidence of abnormal Pap smears is higher in HIV infected women. Exfoliative cervico vaginal cytology has been regarded as the gold standard for cervical screening programs. Pap smear is widely recognized as the most cost effective cancer screening test devised and serves as a model for screening of other malignancies. • The availability of cervical cytology to screen for cervical cancer often permits diagnosis at the pre invasive stage, when treatment can almost always prevent progression to invasive cancer. • For this reason, screening for cervical cancer is important in HIV infected women since the incidence of cervical intraepithelial neoplasia and cancer cervix are four to five times higher in HIV-positive women