Cervical Cancer Screening in HIV-Positive Individuals
This 28-year-old transgender male with HIV requires annual Papanicolaou smear screening, making option A correct. 1
HIV-Specific Screening Guidelines Override General Population Recommendations
The key clinical distinction here is that individuals with HIV are explicitly excluded from standard cervical cancer screening guidelines and require more intensive surveillance regardless of age or CD4 count. 1
Annual Screening Protocol for HIV-Positive Patients
Women who are HIV-positive should be tested twice during the first year after diagnosis, and annually thereafter, according to US Public Health Service (USPHS) and Infectious Disease Society of America (IDSA) guidelines. 1
This annual screening recommendation applies to all HIV-positive individuals with a cervix, regardless of CD4 count, making option C incorrect—the CD4 threshold of 200 cells/mm³ is not relevant to screening indication. 1
The patient's CD4 count of 423 cells/mm³ does not exempt them from annual screening; even well-controlled HIV requires more frequent surveillance than the general population. 1
Why Standard 3-Year Intervals Don't Apply
The general population recommendation of screening every 3 years (option B) applies only to average-risk women aged 21-65 years. 1, 2
HIV infection confers immunocompromised status, placing patients at substantially higher risk for HPV persistence and progression to cervical dysplasia. 1, 3
Studies demonstrate that HIV-infected women have HPV prevalence rates of 57.7%, with higher rates of high-grade squamous intraepithelial lesions compared to HIV-negative women. 3
Age Is Not the Primary Indication Here
While option D correctly identifies that screening should begin by age 21-25 years in the general population, the primary indication for this patient is HIV status, not age. 1
The USPSTF and other guidelines explicitly state their recommendations "do not apply to individuals with a compromised immune system (e.g., women living with HIV)." 1
Clinical Implementation
This patient should have had their first Pap smear at HIV diagnosis (or shortly thereafter if recently diagnosed). 1
A second Pap smear should be performed within the first year, followed by annual screening indefinitely. 1
There is no specific age to stop screening for HIV-positive patients—screening should continue for as long as they are in reasonably good health and would benefit from early detection and treatment. 1
Common Pitfall to Avoid
The most critical error would be applying general population screening intervals (every 3 years) to an HIV-positive patient, which would result in inadequate surveillance and missed opportunities for early detection of cervical dysplasia. 1 Even with excellent virologic control on antiretroviral therapy, annual screening remains indicated. 1