People living with well-controlled HIV are no longer recommended to undergo annual routine cervical screening. They should now be managed in accordance with the national cervical screening programme applicable to people who are not living with HIV.
For people living with HIV that is not well controlled (for example ongoing or recurrent viraemia), or where there is poor adherence to antiretroviral treatment, persistently low CD4 count (<200 cells/mm3) or other concurrent causes of clinically significant immunosuppression, additional annual screening may be considered. Where such an individual tests hrHPV negative, a clinician-taken cervical screening sample may be requested annually by their managing HIV clinician.
This enhanced screening pathway is outside the routine NHS Cervical Screening Programme call and recall process and should:
- Be initiated by the clinician managing the individual’s HIV;
- Be undertaken through a specialist HIV clinic;
- Be agreed with the cervical screening laboratory on a test-by-test basis before the sample is taken, to ensure that it is processed rather than rejected as out of programme; and
- Include clinician responsibility for patient selection, requesting the annual screen and checking that the laboratory has issued the appropriate recall interval.
The NHS Cervical Screening Programme anticipates that very few people living with HIV will require this additional annual screening pathway.
These recommendations supersede statements elsewhere in these guidelines that routine annual cervical screening is recommended for all people living with HIV.
These changes currently relate specifically to the NHS Cervical Screening Programme in England. Clinicians practising elsewhere in the UK should follow the current cervical screening programme guidance for their nation.