Knowledge and use of papanicolaou test among HIV‐positive women

Abstract

Dear Sir,It is well known that women who are infected with the human immunodeficiency virus (HIV) have higher rates of infection with human Papillomaviruses (HPV) 1,2 and that these women present an approximately 10-fold higher risk for invasive cervical cancer (ICC) than age-matched women in the general population. 3 In addition to the high frequency of HPV infection, the increased ICC risk in HIVpositive women could be explained by the immunosuppressive effect of HIV, which may accelerate HPV-related oncogenesis. 4,5 Moreover, because of life-styles often associated with HIV infection (e.g., use of intravenous drugs and prostitution), HIV-positive women may be less likely to receive appropriate cervical screening through Papanicolaou (Pap)-smear than HIV-negative women.In this epidemiological research, we investigated I) the extent to which HIV-infected women were aware that Pap-smear could prevent cervical cancer, ii) factors eventually associated with lack of awareness of Pap-smear, and iii) whether lack of awareness affected the use of Pap-smear screening.A cross-sectional study was conducted between January 2003 and June 2004 at the HIV Outpatient Gynaecological Clinic of the National Institute for Infectious Disease L. Spallanzani, Rome. During this period, 534 HIV-positive women were referred by infectious disease specialists for gynaecological examination, including Pap-smear and, when appropriate, colposcopy. Of these 534 HIV-positive women, 147 were not timely traced. According to a protocol approved by the Ethical Committee of the National Institute for Infectious Disease L. Spallanzani, Rome, 387 women (72.5%) were thus invited to take part in the study. Three hundred eighty-one of them accepted participation and signed the informed consent. Following the aim of this analysis, 44 out of the 381 HIV-positive women who accepted participation were excluded because of missing information on the study endpoint: the remaining 337 HIV-positive women constitute the study group.Relevant information was collected through a questionnaire-based interview that was conducted, before the gynaecological examination, by 2 gynaecologists (CP and GP). To assess awareness of the Pap-smear, study participants were first asked if they were ever told about Pap-smear and, second, if they knew that Pap-smear was a cancer preventive tool. Following the aims of this analysis, women who knew that a Pap-test was used to prevent cervical cancer (or cancer of the uterus) were considered aware of Pap-smear. Other collected data included sociodemographic factors (e.g., age, education and country of origin), smoking and reproductive history, sexual habits (e.g., age at first intercourse, number of partners and contraceptive methods) and history of HIV infection (e.g., date of first seropositive test and mode of HIV acquisition). History of Papsmear was investigated in detail to assess lifetime testing, age at first smear, number of smears done in the 5 years and in the last year preceding the interview, and a self-reported history o...

Self-reported history of Pap-smear in HIV-positive women in Northern Italy: a cross-sectional study

“…Conversely, receiving screening advice from a gynecologist significantly improved the adherence to Pap-smear. We found less influence of education level or country of birth than a previous cross-sectional study conducted in Rome [13]. As expected, study women reported a high proportion of previous abnormal Pap-smears (34%), in agreement with previous reports among HIV-positive women in Italy [13] and the United States [8,9].…”

“…These proportions are similar to the ones reported by the general population of the same age and geographical area (95% and 47%, respectively) (Carrozzi and Bertozzi, personal communication), and substantially higher than those reported (43%) in 2001 by a physician-based Italian survey [14]. Increase in the number of Pap-smears performed, however, is difficult to evaluate, given the different study designs of previous studies conducted in Italy [13,14]. The proportion of women who had a Pap-smear in the last year, however, remains suboptimal with respect to current guidelines regarding HIV-positive women (annual Pap-smear recommended to all patients), and is lower than the estimates (approximately 80%) reported in the USA [8,9].…”

“…A large cross-sectional study showed not only a scanty use of Pap-smear among HIV-positive Italian women, but also that these women did not know that a Pap-test was used to prevent cervical cancer [13]. In addition, a survey conducted among clinicians in 27 Italian HIV centers showed low compliance with the published guidelines on gynecologic follow-up of HIV-positive women in Italy [14].…”

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

“…Studies have also shown that women with a history of STIs and/or pregnancy, which may correlate with number of sexual partners, are more likely to undergo Pap screening [28,33]. Having acquired HIV heterosexually was also associated with better adherence to Pap testing (OR 3.2); this is in keeping with multiple other studies, which have determined that women who acquire HIV perinatally [33], and women who use intravenous drugs [8,24,26,36,53], have poorer screening rates than those who acquire HIV through sexual intercourse with a male.…”

“…The association between older age and lack of Pap testing may be related to the misconception that Pap testing is no longer necessary after menopause [20,52]. Sadly, there is a linear relationship between diagnosis of cervical cancer and age [44,48,53], with most deaths from invasive cervical cancer occurring in those over the age of 50 years [54]; therefore continued Pap testing in older women is essential.…”