Abstract
IntroductionHIV-positive women have an increased risk of invasive cervical cancer but cytologic screening is effective in reducing incidence. Little is known about cervical screening coverage or the prevalence of abnormal cytology among HIV-positive women in Ukraine, which has the most severe HIV epidemic in Europe.MethodsPoisson regression models were fitted to data from 1120 women enrolled at three sites of the Ukraine Cohort Study of HIV-infected Childbearing Women to investigate factors associated with receiving cervical screening as part of HIV care. All women had been diagnosed as HIV-positive before or during their most recent pregnancy. Prevalence of cervical abnormalities (high/low grade squamous intraepithelial lesions) among women who had been screened was estimated, and associated factors explored.ResultsOverall, 30% (337/1120) of women had received a cervical screening test as part of HIV care at study enrolment (median 10 months postpartum), a third (115/334) of whom had been tested >12 months previously. In adjusted analyses, women diagnosed as HIV-positive during (vs before) their most recent pregnancy were significantly less likely to have a screening test reported, on adjusting for other potential risk factors (adjusted prevalence ratio (APR) 0.62, 95% CI 0.51–0.75 p<0.01 for 1st/2nd trimester diagnosis and APR 0.42, 95% CI 0.28–0.63 p<0.01 for 3rd trimester/intrapartum diagnosis). Among those with a cervical screening result reported at any time (including follow-up), 21% (68/325) had a finding of cervical abnormality. In adjusted analyses, Herpes simplex virus 2 seropositivity and a recent diagnosis of bacterial vaginosis were associated with an increased risk of abnormal cervical cytology (APR 1.83 95% CI 1.07–3.11 and APR 3.49 95% CI 2.11–5.76 respectively).ConclusionsIn this high risk population, cervical screening coverage as part of HIV care was low and could be improved by an organised cervical screening programme for HIV-positive women. Bacterial vaginosis testing and treatment may reduce vulnerability to cervical abnormalities.
Highlights
HIV-positive women have an increased risk of invasive cervical cancer but cytologic screening is effective in reducing incidence
Heterosexual transmission has overtaken injecting drug use (IDU) as the main mode of HIV acquisition [2], and women account for almost half of those living with HIV in Ukraine [3]
We aimed to explore coverage of cervical screening as part of HIV care in a cohort of HIV-positive childbearing women in Ukraine receiving care at HIV/AIDS Centres, and to identify factors associated with an abnormal finding
Summary
HIV-positive women have an increased risk of invasive cervical cancer but cytologic screening is effective in reducing incidence. Little is known about cervical screening coverage or the prevalence of abnormal cytology among HIVpositive women in Ukraine, which has the most severe HIV epidemic in Europe. HIV-positive women are at increased risk of acquisition and/or persistence or reactivation of cervical infection with Human papillomavirus (HPV) [4,5,6]. Cervical abnormalities in HIVpositive women are more likely to be severe, aggressive and resistant to treatment [9,10], and HIV-positive women have a 5 to 8-fold increased risk of invasive cervical cancer compared with the general population [11,12]. Cytologic samples taken during pregnancy (and up to 12 weeks postpartum) may be more difficult to interpret than samples taken at other times [20]
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