Cervical Pap Screening Cytological Abnormalities among HIV-Infected Adolescents in the LEGACY Cohort

Abstract

Objectives To determine the prevalence of cervical Pap screening (CPAP-S), identify factors associated with CPAP-S, and explore risk factors for abnormal cervical cytology in female adolescents with perinatally and behaviorally acquired HIV infection. Design Cross-sectional Setting LEGACY is a national observational cohort chart review study of 1478 HIV-infected persons (≤ age 24 years) managed in 22 HIV specialty clinics in the United States. Participants Sexually active females aged ≥13–24 years in the LEGACY cohort Main Outcome measures CPAP-S & abnormal cervical cytology. Results Of 231 sexually active female participants (>= 13 years) in 2006, 49% had CPAP-S documented since 2001. 58% of 113 cervical tests were abnormal (2% high-grade). In multivariable analysis, perinatal HIV infection and black race were associated with decreased likelihood of CPAP-S (adjusted prevalence ratio [APR] 0.66, 95% CI 0.45, 0.96 and APR 0.74, 95% CI 0.56, 0.96, respectively). Presence of any STI was independently associated with increased likelihood of CPAP-S (APR 1.56, 95% CI 1.21, 2.02). CD4+ T-lymphocyte count <200 cells/mL and previous STI were independently associated with increased likelihood of abnormal cervical cytology (APR 2.19, 95% CI 1.26, 3.78 & APR 1.94, 95% CI 1.29, 2.92, respectively). Conclusions Among sexually active HIV-infected adolescent females, prevalence of CPAP-S was low and cytology was abnormal in more than half of Pap smears. Perinatally HIV-infected, sexually active females were less likely to undergo CPAP-S than their behaviorally HIV-infected counterparts. Interventions targeted at HIV-infected adolescents and care providers are needed to improve CPAP-S in HIV-infected young women, especially those with perinatally acquired HIV infection.

Sexual and reproductive health in a UK cohort of young adults perinatally infected with HIV

“…Data from our cohort for sexual activity, age at coitarche and median number of lifetime partners are in agreement with UK national survey data of the general population 9. Genital warts was the commonest STI in our cohort, as with US studies,6 7 while in the UK general population for this age group it was CT 9. Statistical analysis of our data on sexual behaviour revealed only two significant differences between the sexes: the number of lifetime partners, and coitarche-first STI screen interval.…”

Cervical Cancer Screening in Immunocompromised Women

“…In addition, the occurrence of HSIL was significantly associated with persistent LSIL and a positive HPV test. Setse and colleagues 45 reported the prevalence of abnormal Pap tests among sexually active girls and young women (13-24 years of age) followed in the Longitudinal Epidemiologic Study to Gain Insight into HIV/AIDS in Children and Youth (LEGACY) cohort between November 2005 and June 2007. There were 231 eligible participants, 46% perinatally infected and 54% behaviorally infected, of whom 49% had at least 1 Pap test.…”

Rates and Correlates of Self-Reported Pap Testing in African-Caribbean-Black HIV-Positive Women in Ontario, Canada

“…On the other hand, women with HIV also have frequent contact with health care providers, a factor which has been shown to increase adherence to regular Pap screening [24][25]. There have been several studies examining Pap testing in the HIV-positive community and rates of screening range from 30% to 88% [26][27][28][29][30][31][32][33][34]. Factors associated with regular screening include access to a primary care physician [30] or gynecologist [27][28][29], while the lack of regular screening is predicted by older [28,35,36] or younger [29] age, lower education level [29,35], intravenous drug use [26,35,36] and having a CD4+ count <200 cells/mm [3,29,36].…”