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in persons with HIV infection. A meta-analysis showed the TST had good sensitivity except in patients with prior BCG and IGRA was preferred in that population (Ann Intern Med 2007;146:340).. Studies to determine relative merits of these tests to detect latent TB in persons with HIV infection are ongoing (Ann Intern Med 2007; 146:340).
Pap Smear: The CDC recommends that a gynecological evaluation with pelvic exam and Pap smear be performed at baseline, repeated at 6 months and annually thereafter (MMWR 2002;517[RR-6]:59; JAMA 1994;271:1866; MMWR 1999;48[RR-10]:31), with management according to guidelines in Table 2-27 (below). More aggressive test ing is recommended because of a several-fold increase in rates of squamous intra epithelial lesion (SIL) (33% to 45% HIV+ vs 7% to 14% HIV-) and a 0- to 9-fold increase in rates of cervical cancer in women with HIV (Arch Pediatr Adolesc Med 2000;154:127; Obstet Gynecol Clin N Am 1996; 23,861; JAIDS 2003;32:527; JAIDS 2004;36:978). Severity and frequency of cervical dysplasia increase with progressive immune compro - mise. There is a strong association between HIV infection and detectable and per sistent HPV infection by HPV types associated with cervical
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TABLE 2-17: