Anglian Genitourinary Medicine Audit Group — cervical cytology screening in HIV-positive women

Abstract

Immunosuppressed HIV-infected women are at risk of developing cervical cytological abnormalities and should have routine annual cervical cytology smears performed as recommended by the National Health Services Cervical Screening Programme (NHSCSP). In the Anglian Genitourinary Medicine Audit Group review of practice of cervical cytology smears, only 55.5% of clinics met the NHSCSP standards. The mean age of the 173 women in the cohort was 35.8 +/- 8.1, range 16-66 years. Seventy-eight percent of clinics performed cervical cytology screening in women under the age of 25 years. High-grade cervical cytological abnormality (moderate dyskariosis and above) was seen in 9.5% of the cohort and 39.5% had low-grade lesions (borderline and mild dyskariosis). One patient, a 41-year-old black African on highly active antiretroviral therapy with HIV-1 RNA level <50 copies/mL and a CD4 count of 240 cells/mm(3) had invasive cervical cancer requiring hysterectomy. The expected mean number of cervical cytology smears for the cohort was 3.29 and the calculated performed mean cervical cytology smear was 1.9 (P = 0.0001), a statistically significant difference. Asylum dispersal among 69.5% black Africans in the cohort contributed to some of the clinics not meeting the NHSCSP standards.