Assessing cervical intraepithelial neoplasia as an indicator disease for HIV in a low endemic setting: a population-based register study.
BJOG
; 124(11): 1680-1687, 2017 Oct.
Article
in En
| MEDLINE
| ID: mdl-28235246
ABSTRACT
OBJECTIVES:
To analyse whether the prevalence of undiagnosed HIV among (1) all women in Sweden and (2) migrant women, diagnosed with cervical intraepithelial neoplasia grade 2 or worse CIN2+ reaches the threshold of 0.1%, which has been suggested to be cost-effective for HIV testing.DESIGN:
Population-based register study.SETTING:
Counties of Stockholm and Gothenburg, Sweden, 1990-2014. POPULATION All women, born between 1940 and 1990, with at least one cervical cytology or histology registered in the Swedish National Cervical Screening Register (NKCx).METHODS:
Data were collected from the NKCx and the Swedish National HIV register. The proportion of women with undiagnosed HIV among women with CIN2+ compared with women with a normal/mildly abnormal cytology/histology was assessed. MAIN OUTCOMEMEASURES:
Proportion of women with undiagnosed HIV.RESULTS:
The proportion of undiagnosed HIV was higher among all women with CIN2+ than among those without CIN2+ 0.06% (95% CI 0.04-0.08) versus 0.04% (95% CI 0.04-0.04); P = 0.017). Among migrant women, the proportion of undiagnosed HIV was higher among those with CIN2+ than among those without [0.30% (95% CI 0.20-0.43) versus 0.08% (95% CI 0.07-0.10); P < 0.001] and exceeded 0.1%, suggesting the cost-effectiveness of HIV testing. Women with undiagnosed HIV at the time of CIN2+ had a significantly lower nadir CD4+ T-cell count, as a measure of immunosuppression, compared with women without CIN2+ before HIV diagnosis (median nadir CD4, 95 cells/mm3 versus 210 cells/mm3 ; P < 0.01).CONCLUSIONS:
HIV testing should be performed in migrant women with unknown HIV status diagnosed with CIN2+ . TWEETABLE ABSTRACT HIV testing should be performed in migrant women with unknown HIV status diagnosed with CIN2+ .Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Transients and Migrants
/
Vaginal Smears
/
HIV Infections
/
Uterine Cervical Dysplasia
/
Cervix Uteri
/
Mass Screening
/
Papillomavirus Infections
Type of study:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Middle aged
Country/Region as subject:
Europa
Language:
En
Journal:
BJOG
Journal subject:
GINECOLOGIA
/
OBSTETRICIA
Year:
2017
Document type:
Article
Affiliation country:
Sweden