Human papillomavirus infection in HIV-1 infected women in Catalonia (Spain): implications for prevention of cervical cancer.

BACKGROUND: High-risk human Papillomavirus infection is a necessary factor for cervical squamous intraepithelial lesions and invasive cervical cancer. In HIV-1-infected women, HPV infection is more prevalent and a higher risk of cervical cancer has been identified. We aimed to calculate the prevalence of infection by HR-HPV, determine the factors associated with this infection and abnormal cytology findings and to describe the history of cervical cancer screening in HIV-1-infected women. METHODS: We enrolled 479 HIV-1-infected women from the PISCIS cohort. Each patient underwent a gynecological check-up, PAP smear, HPV AND Hybrid capture, HPV genotyping, and colposcopy and biopsy, if necessary. We applied questionnaires to obtain information on sociodemographic, behavioral, clinical, and cervical screening variables. We present a cross-sectional analysis. RESULTS: Median age was 42 years. The prevalence of HR-HPV infection was 33.2% and that of high-grade squamous intraepithelial lesions (HSIL) was 3.8%. The most common genotypes were 16(23%), 53(20.3%), and 52(16.2%). The factor associated with HR-HPV infection was age <30 years (odds ratio[OR],2.5; 95%confidence interval[CI],1.1-5.6). The factors associated with the presence of HSIL or low-grade squamous intraepithelial lesions (LSIL) were CD4T-lymphocyte count <200 cells/mm(3) versus >500 cells/mm(3) (OR,8.4; 95%CI,3.7-19.2), HIV-1 viral load >10,000 copies/mL versus <400 copies/mL (OR,2.1; 95%CI,1.0-4.4), and use of oral contraceptives (OR,2.0; 95%CI,1.0-3.9). Sixty percent of HIV-1-infected women had had one Pap smear within the last 2 years. CONCLUSIONS: The high prevalence of HPV infection and cervical lesions in the HIV-1-infected population in Catalonia, as well as the low coverage and frequency of screening in this group, means that better preventive efforts are necessary and should include vaccination against HPV, better accessibility to screening programs, training of health care professionals, and specific health education for HIV-1-infected women.

Diferencias en la morbilidad neonatal entre neonatos magrebíes y autóctonos / Differences in neonatal morbidity rates between native and magrebi newborns

Fundamento. Alto porcentaje de nacimientos de inmigrantesen nuestro entorno e impresión de mayor morbilidadperinatal. Objetivo. Valorar si existen diferencias entre la morbilidadneonatal de dos poblaciones y posibles factoresmodificables.Método. Estudio descriptivo retrospectivo a partir derevisiones de historias clínicas correspondientes a los partosdel año 2000 (596 partos) en el Hospital de Palamós.Análisis estadístico del resultado del parto en 115 gestantesmagrebíes y 115 autóctonas; y de la morbilidad neonatalen 114 neonatos magribíes y 457 autóctonos.Resultados. -Parto: En el grupo magrebí, mayor númerode partos eutócicos, menor de cesáreas y menor usode analgesia durante el parto (p<0,01). -Neonatal: En elgrupo magrebí, mayor porcentaje de ingresos neonatales(p<0,01). Los principales motivos de ingreso en los dos gruposson el riesgo de infección (50,9% entre los autóctonosy 73,07% entre los magrebíes, p<0,01) y la hiperbilirrubinemia(15,45% y 19,23% respectivamente). El índice deriesgo por madre portadora de estreptococo β hemolíticodel grupo B o desconocido es el resultado con mayor diferenciaentre los dos grupos (p<0,01), por encima de la roturaprolongada de membranas (p<0,05). Más neonatoscon peso por encima del percentil 90 (p<0,05).Conclusiones. Las diferencias halladas en el análisis delparto deben atribuirse a la mayor paridad de las magribins.En lo referente a la morbilidad neonatal es difícil igualarlos dos grupos dado que hay factores sobre los que no sepuede incidir. Creemos sería útil aplicar medidas especialessobre el grupo de inmigrantes y evaluar los resultados

Background. In recent years, there has been a significantincrease in the percentage of births from immigrantpopulation, with a perceived increased perinatal morbidity.Objective. To compare neonatal morbidity rates betweenimmigrant population of Magrebi origin and nativepopulation, and to determine possible modifiable factors.Method. Historical descriptive study based on a reviewof clinical records of infants born in 2000 (596 deliveries) atthe Palamos Hospital. The outcome of the pregnancies of115 Magrebi and 115 native women, and the neonatal morbidityin 114 and 457 native newborns, were compared.Results. Deliveries: In the Magrebi group, a higher proportionof eutocic deliveries, fewer cesarean sections, andless use of analgesics during the labour, were found(p<0.01). Neonatal morbidity: In the Magrebi group, wefound a higher percentage of neonatal admissions (p<0.01).In both groups, the main reasons for admission were therisk of infection (50.9% and 73.0% in the native and Magrebipopulations, respectively, p<0.01) and hyperbilirrubinemia(15.4% and 19.2%, respectively). The greatest difference in risk index in the Magrebi population was for mothers carryinggroup B β hemolytic streptococcus or with unknowncarrier status, (p<0.01), followed by prolonged membranerupture (p<0.05). A greater proportion of Magrebi newbornshad birth weight above the 90th percentile (p<0.05).Conclusions. The differences in the analysis of the deliveriesare probably related to the higher parity amongthe Magrebi families. Regarding the differences in neonatalmorbidity rates, interventions aiming at decreasing thisgap are challenging, given the disparities between bothpopulations. We suggest that special measures are appliedto the immigrant group