Adherence to the cervical cancer screening program in women living with HIV in Denmark: comparison with the general population

Thorsteinsson, Kristina; Ladelund, Steen; Jensen-Fangel, Søren; Katzenstein, Terese L.; Johansen, Işik Somuncu; Pedersen, Gert Frølund; Junge, Jette; Helleberg, Marie; Storgaard, Merete; Lebech, Anne‐Mette

doi:10.1186/1471-2334-14-256

Cited by 24 publications

(28 citation statements)

References 27 publications

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“…This suggests that women who are in care for longer periods might have a better understanding of the necessity of gynaecological supervision and be more willing to return to the HIV clinic for IGC. A recent Danish populational study showed comparable results, with CD4 count > 350 cells/μL and HIV RNA < 500 copies/mL being predictors of attendance at the HIV cervical screening program [14]. In the Danish study only 2.6% of HIV positive women obtained the recommended two cervical cancer screenings in the first year from HIV diagnosis.…”

Section: Discussionmentioning

confidence: 80%

“…However, data coming from observational studies in Europe, although scarce, shows that barriers to cervical cancer screening still exist, from both the patient's and the health system's perspectives [14,15,20]. It is important to note that according to a recently published EuroSIDA study of a pan-European longitudinal observational cohort, cancer screening has a low coverage in both Eastern and non-Eastern European countries [21].…”

Section: Discussionmentioning

confidence: 99%

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Barriers to cervical cancer screening exist despite integrating HIV and gynaecological services for HIV-positive women in Poland

Kowalska¹,

Wróblewska

Ząbek³

et al. 2018

Ginekol Pol

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Objectives: HIV-positive women are at increased risk of HPV infection and cervical cancer. European and national guidelines advise yearly screening for cervical cancer, however due to the lack of a central registration of HIV infected persons there is a gap in offering such care through general healthcare services in many countries, including Poland. Material and methods:In response to the above limitations, integrated gynaecological care (IGC) was established at the HIV Out-Patient Clinic in Warsaw. We analysed data from January 2007 to May 2014. Logistic regression models were used to identify factors associated with not using IGC by patients.Results: Two hundred and forty women were registered in the observation period:59.6% infected through sexual contact, 18.7% through IDUs, 19.2 % through unknown causes and 2.5% by other (two were vertically infected). The median follow-up time was 2.35 (IQR 0.9-4.5) years and 78.3% were on combination antiretroviral therapy (cART). In total 145 of the women (60.4%) used IGC, from 72.1% of those registered in 2007 to 27.3% registered in 2014. There were in total 1075 gynaecological visits and 254 cervical cytology tests performed. Seventy-five (51.7%) women were tested for HPV infection. Factors decreasing the odds of not using IGC identified by multivariate regression models were being on cART (OR 0.25 Conclusions:The utilisation of IGC was very high, but with a delay in commencing the IGC. Women on cART and with longer periods of follow-up had lower odds of not using IGC. A screening approach for women not yet on cART, or newly registered in the clinics, needs special attention.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Barriers to cervical cancer screening exist despite integrating HIV and gynaecological services for HIV-positive women in Poland

Kowalska¹,

Wróblewska

Ząbek³

et al. 2018

Ginekol Pol

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“…A high proportion of WLWH included and not included in the study; 28.7 % and 52.5 %, had not been screened for CC in the preceding 3 to 5 years. We have previously assessed low screening attendance in this cohort of WLWH and support the idea of cytology as part of an annual medical HIV review, integration of HIV care and cervical screening in a single clinic setting and targeted public health messages aimed at health care professionals at HIV centres, general practitioners and WLWH [37]. However, the low screening attendance does not explain differences in cytological abnormalities between WLWH and WGP, since women were matched on prior screening history.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and distribution of cervical high-risk human papillomavirus and cytological abnormalities in women living with HIV in Denmark – the SHADE

et al. 2016

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BackgroundWomen living with HIV (WLWH) are at increased risk of persistent human papillomavirus (HPV) infection, cervical dysplasia and cervical cancer compared with women from the general population (WGP). We assessed the prevalence and distribution of cervical high-risk (hr) HPV infection and cytological abnormalities in WLWH compared with WGP in Denmark. Predictors of HPV and cytological abnormalities were estimated in WLWH.MethodsWLWH consecutively enrolled in the Study on HIV, cervical Abnormalities and infections in women in Denmark (SHADE) in 2011 and were examined for cervical HPV and cytological abnormalities.WLWH were matched on age and prior cytological findings with WGP from an earlier study. HIV demographics were retrieved from the nationwide Danish HIV Cohort Study. Logistic regression was used to estimate predictors of hrHPV and cytological abnormalities.ResultsOf 334 included WLWH 26.4 % were positive for hrHPV as opposed to 16.6 % WGP (p < 0.0001). WLWH had a higher number of multiple infections (>1 h genotype present) (38.5 % versus 25.7 %, p = 0.030). Hr genotypes in descending order of frequency were HPV58 (7.1 %), 52 (5.4 %), and 16 (4.8 %) in WLWH versus HPV16 (4.1 %), 52 (2.8 %) and 58 (2.4 %) in WGP. Predictors of hrHPV in WLWH were short duration of HAART (adjusted OR per year 0.90 (95 % CI 0.84-0.96)), AIDS prior to inclusion (adjusted OR 3.61 (95 % CI 1.75-7.46)), ≥5 lifetime sexual partners (adjusted OR 2.20 (95 % CI 1.08-4.49)), sexual debut <16 years of age (adjusted OR 2.05 (95 % CI 1.03-4.10)) and CD4 < 350 cells/μL (adjusted OR 2.53 (95 % CI 1.20-5.40)). Cytological abnormalities were prevalent in 10.4 % vs. 5.2 % (p = 0.0003) of WLWH and WGP. In WLWH with hrHPV, short duration of HAART predicted cervical dysplasia (adjusted OR per year 0.83 (95 % CI 0.71-0.97)).ConclusionsWLWH presented with more cervical hrHPV infections and cytological abnormalities, and a different distribution of hrHPV genotypes compared with WGP. Cervical hrHPV and cytological abnormalities were predicted by short duration of HAART.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2881-1) contains supplementary material, which is available to authorized users.

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“…Nonetheless, the direct effect of immunosuppression on invasive cancer risk is still debated [69][70][71] . Recent studies suggest that there is no increased risk of SCC in HIV-positive women when adherence to the strict cervical cancer screening programs is complete [72]. Accordingly, there is a need for improving awareness of the importance of cervical M A N U S C R I P T…”

Section: Hpv-associated Cervical Cancermentioning

confidence: 99%

“…12 cancer screening, that is still partial in the HIV+ women [72] and probably, even lower in female transplant patients.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Immunodeficiency-associated viral oncogenesis

Pierangeli

Antonelli

Gentile

2015

Clinical Microbiology and Infection

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Several viruses with different replication mechanisms contribute to oncogenesis by both direct and indirect mechanisms in immunosuppressed subjects after solid organ transplantation, after allogeneic stem cell transplantation, or with human immunodeficiency virus (HIV) infection. Epstein-Barr virus (EBV), human papillomavirus (HPV), Kaposi sarcoma herpesvirus (KSHV), human T-cell lymphotropic virus type 1 (HTLV-1) and Merkel cell polyoma virus (MCV) are the main viruses associated with the development of cancer in immunosuppressed patients. Besides being a main cause of immunodeficiency, HIV1 has a direct pro-oncogenic effect. In this review, we provide an update on the association between the condition of acquired immunodeficiency and cancer risk, specifically addressing the contributions to oncogenesis of HPV, MCV, KSHV, HTLV-1, and EBV.

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Adherence to the cervical cancer screening program in women living with HIV in Denmark: comparison with the general population

Cited by 24 publications

References 27 publications

Barriers to cervical cancer screening exist despite integrating HIV and gynaecological services for HIV-positive women in Poland

Barriers to cervical cancer screening exist despite integrating HIV and gynaecological services for HIV-positive women in Poland

Prevalence and distribution of cervical high-risk human papillomavirus and cytological abnormalities in women living with HIV in Denmark – the SHADE

Immunodeficiency-associated viral oncogenesis

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