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Positive predictive value — USMLE Step 2 CK MCQ

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HardPreventive Medicine & BiostatisticsPositive predictive valueUSMLE Step 2 CK

A 34-year-old woman with well-controlled HIV has cervical cytology negative for intraepithelial lesion and a negative high-risk HPV test. Two previous annual cotests were also both negative. She has no prior CIN2+ and is not pregnant. What is the most appropriate screening interval?

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Correct answer: A — Repeat cytology plus HPV cotesting in 3 years

For a person with HIV aged 30 or older, cytology plus high-risk HPV cotesting is acceptable. After three consecutive annual negative cotests, the interval can be extended to 3 years. The average-risk 5-year interval does not apply, and screening should continue throughout life rather than automatically ending at 65. Colposcopy is not indicated for negative cytology and HPV results. Primary HPV testing alone is not the cited HIV-specific strategy. The stem deliberately supplies repeated negative results because one negative cotest would ordinarily be followed sooner in the HIV algorithm.

Reference: NIH Adult and Adolescent OI Guideline: Human Papillomavirus Disease: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/human