A 32-Year-Old Nulliparous Woman with HIV Comes to the Physician

A 32-year-old nulliparous woman with HIV comes to the physician for a pelvic examination and Pap smear. The patient acquired HIV from her mother at birth and has been noncompliant with health maintenance visits. Menarche occurred at the age of 10 years. She became sexually active at the age of 14 years. Her mother had cervical cancer at the age of 51 years. She is 165 cm (5 ft 5 in) tall and weighs 79 kg (174 lb) ; BMI is 29 kg/m2. Examination shows mild facial acne. A Pap smear shows high-grade cervical intraepithelial neoplasia. Which of the following is this patient's strongest predisposing factor for developing this condition?

A) Age at first intercourse
B) Nulliparity
C) Early menarche
D) Family history of cervical cancer
E) Immunosuppression

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