Document Detail


Cervical screening within HIV care: findings from an HIV-positive cohort in Ukraine.
MedLine Citation:
PMID:  22545087     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: HIV-positive women have an increased risk of invasive cervical cancer but cytologic screening is effective in reducing incidence. Little is known about cervical screening coverage or the prevalence of abnormal cytology among HIV-positive women in Ukraine, which has the most severe HIV epidemic in Europe.
METHODS: Poisson regression models were fitted to data from 1120 women enrolled at three sites of the Ukraine Cohort Study of HIV-infected Childbearing Women to investigate factors associated with receiving cervical screening as part of HIV care. All women had been diagnosed as HIV-positive before or during their most recent pregnancy. Prevalence of cervical abnormalities (high/low grade squamous intraepithelial lesions) among women who had been screened was estimated, and associated factors explored.
RESULTS: Overall, 30% (337/1120) of women had received a cervical screening test as part of HIV care at study enrolment (median 10 months postpartum), a third (115/334) of whom had been tested >12 months previously. In adjusted analyses, women diagnosed as HIV-positive during (vs before) their most recent pregnancy were significantly less likely to have a screening test reported, on adjusting for other potential risk factors (adjusted prevalence ratio (APR) 0.62, 95% CI 0.51-0.75 p<0.01 for 1(st)/2(nd) trimester diagnosis and APR 0.42, 95% CI 0.28-0.63 p<0.01 for 3(rd) trimester/intrapartum diagnosis). Among those with a cervical screening result reported at any time (including follow-up), 21% (68/325) had a finding of cervical abnormality. In adjusted analyses, Herpes simplex virus 2 seropositivity and a recent diagnosis of bacterial vaginosis were associated with an increased risk of abnormal cervical cytology (APR 1.83 95% CI 1.07-3.11 and APR 3.49 95% CI 2.11-5.76 respectively).
CONCLUSIONS: In this high risk population, cervical screening coverage as part of HIV care was low and could be improved by an organised cervical screening programme for HIV-positive women. Bacterial vaginosis testing and treatment may reduce vulnerability to cervical abnormalities.
Authors:
Heather Bailey; Claire Thorne; Igor Semenenko; Ruslan Malyuta; Rostislav Tereschenko; Irina Adeyanova; Elena Kulakovskaya; Lyudmila Ostrovskaya; Liliana Kvasha; Mario Cortina-Borja; Claire L Townsend
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-04-24
Journal Detail:
Title:  PloS one     Volume:  7     ISSN:  1932-6203     ISO Abbreviation:  PLoS ONE     Publication Date:  2012  
Date Detail:
Created Date:  2012-04-30     Completed Date:  2012-08-27     Revised Date:  2013-06-25    
Medline Journal Info:
Nlm Unique ID:  101285081     Medline TA:  PLoS One     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e34706     Citation Subset:  IM    
Affiliation:
MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, University College London, London, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cervix Uteri / microbiology,  pathology*,  virology
Cohort Studies
Female
HIV Infections / complications*,  diagnosis,  epidemiology
HIV-1 / isolation & purification
Humans
Pregnancy
Ukraine / epidemiology
Uterine Cervical Neoplasms / complications,  diagnosis*,  pathology
Vaginal Smears
Vaginosis, Bacterial / complications,  diagnosis*,  pathology
Young Adult
Grant Support
ID/Acronym/Agency:
081082//Wellcome Trust; 081082//Wellcome Trust; G0400546//Medical Research Council; //Department of Health
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