title: Cervical pap screening cytological abnormalities among HIV-infected adolescents in the LEGACY cohort.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  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.
  
  
  METHODS
  Sexually active females aged 13-24 years in the LEGACY cohort.
  
  
  METHODS
  CPAP-S and abnormal cervical cytology.
  
  
  RESULTS
  Of 231 sexually active female LEGACY participants 13-24 years of age 49% had documentation of CPAP-S between 2001 and 2006. Fifty-eight percent 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 sexually transmitted infection (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 diagnosis were independently associated with increased likelihood of abnormal cervical cytology (APR 2.19, 95% CI 1.26-3.78 and 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.
authors.affiliation: Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA. rsetse@jhsph.edu
authors.forename: Rosanna
authors.initials: R
authors.lastname: Setse
authors.forename: George K
authors.initials: GK
authors.lastname: Siberry
authors.forename: William J
authors.initials: WJ
authors.lastname: Moss
authors.forename: Patti
authors.initials: P
authors.lastname: Gravitt
authors.forename: Travis
authors.initials: T
authors.lastname: Wheeling
authors.forename: Beverly
authors.initials: B
authors.lastname: Bohannon
authors.forename: Kenneth
authors.initials: K
authors.lastname: Dominguez
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D003627:Data Interpretation, Statistical; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D065006:Papanicolaou Test; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D002577:Uterine Cervical Diseases / Q000175:diagnosis* / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000473:pathology
references.citation: Semin Surg Oncol. 1994 Jan-Feb;10(1):31-46
references.pmid: 8115784
references.citation: AIDS. 1998 Jun 18;12(9):1047-56
references.pmid: 9662202
references.citation: Arch Pediatr Adolesc Med. 2000 Feb;154(2):127-34
references.pmid: 10665598
references.citation: IARC Sci Publ. 1997;(138):369-76
references.pmid: 9353678
references.citation: Cancer. 1999 Aug 25;87(4):184-9
references.pmid: 10455205
references.citation: JAMA. 2000 Feb 23;283(8):1031-7
references.pmid: 10697063
references.citation: N Engl J Med. 1997 Nov 6;337(19):1343-9
references.pmid: 9358128
references.citation: Am J Public Health. 2007 Jun;97(6):1047-52
references.pmid: 17463385
references.citation: J Acquir Immune Defic Syndr. 1999 May 1;21(1):33-41
references.pmid: 10235512
references.citation: Ethn Dis. 1992 Winter;2(1):47-54
references.pmid: 1458215
references.citation: J Acquir Immune Defic Syndr. 2001 Aug 15;27(5):463-6
references.pmid: 11511823
references.citation: J Infect Dis. 1994 Dec;170(6):1404-9
references.pmid: 7995978
references.citation: J Acquir Immune Defic Syndr. 2009 Aug 1;51(4):430-6
references.pmid: 19474756
references.citation: Am J Public Health. 1989 Aug;79(8):1036-7
references.pmid: 2751021
references.citation: Sex Transm Dis. 2006 Apr;33(4):259-64
references.pmid: 16452834
references.citation: Obstet Gynecol. 1995 May;85(5 Pt 1):680-6
references.pmid: 7724095
references.citation: J Infect Dis. 2004 Oct 15;190(8):1413-21
references.pmid: 15378433
references.citation: Clin Infect Dis. 2004 Sep 1;39(5):609-29
references.pmid: 15356773
references.citation: Eur J Epidemiol. 1997 Dec;13(8):937-43
references.pmid: 9476825
references.citation: MMWR Morb Mortal Wkly Rep. 1994 Jul 29;43(29):530-4
references.pmid: 8028574
references.citation: CA Cancer J Clin. 2002 Nov-Dec;52(6):342-62
references.pmid: 12469763
references.citation: J Natl Cancer Inst. 1999 Feb 3;91(3):226-36
references.pmid: 10037100
references.citation: J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Aug 1;9(4):361-70
references.pmid: 7600103
references.citation: Am J Prev Med. 1998 Apr;14(3):201-8
references.pmid: 9569221
references.citation: J Infect Dis. 2004 Jul 1;190(1):37-45
references.pmid: 15195241
references.citation: Lancet. 2004 Nov 6-12;364(9446):1678-83
references.pmid: 15530628
references.citation: CA Cancer J Clin. 2007 Jan-Feb;57(1):7-28
references.pmid: 17237032
references.citation: Top HIV Med. 2007 Aug-Sep;15(4):130-3
references.pmid: 17720998
references.citation: J Clin Pathol. 2008 Jan;61(1):84-8
references.pmid: 17483251
references.citation: Prev Med. 2002 Nov;35(5):463-73
references.pmid: 12431895
references.citation: J Acquir Immune Defic Syndr (1988). 1990;3(9):896-903
references.pmid: 2166784
references.citation: Obstet Gynecol. 1994 Oct;84(4):591-7
references.pmid: 8090399
references.citation: J Adolesc Health. 2006 Jun;38(6):765-8
references.pmid: 16730612
references.citation: Am J Obstet Gynecol. 1991 Aug;165(2):392-400
references.pmid: 1651648
references.citation: BMC Infect Dis. 2010 Oct 14;10:295
references.pmid: 20946655
references.citation: AIDS. 2000 Aug 18;14(12):1775-84
references.pmid: 10985315
references.citation: JAMA. 2002 Apr 24;287(16):2114-9
references.pmid: 11966386
references.citation: MMWR Recomm Rep. 2002 Jun 14;51(RR-8):1-52
references.pmid: 12081007
references.citation: Int J STD AIDS. 2006 Sep;17(9):579-84; quiz 585-7
references.pmid: 16942648
references.citation: Gynecol Obstet Invest. 1995;40(1):52-6
references.pmid: 7557645
references.citation: MMWR Recomm Rep. 2006 Aug 4;55(RR-11):1-94
references.pmid: 16888612