title: Adherence to the cervical cancer screening program in women living with HIV in Denmark: comparison with the general population.
abstract: BACKGROUND
  Women living with HIV (WLWH) are at increased risk of invasive cervical cancer (ICC). International HIV guidelines suggest cervical screening twice the first year after HIV diagnosis and thereafter annually. Adherence to the HIV cervical screening program in Denmark is unknown.
  
  
  METHODS
  We studied women from a population-based, nationwide HIV cohort in Denmark and a cohort of age-matched females from the general population. Screening behaviour was assessed from 1999-2010. Adjusted odds ratios (OR's) for screening attendance in the two cohorts and potential predictors of attendance to guidelines were estimated. Pathology specimens were identified from The Danish Pathology Data Bank.
  
  
  RESULTS
  We followed 1143 WLWH and 17,145 controls with no prior history of ICC for 9,509 and 157,362 person-years. The first year after HIV diagnosis 2.6% of WLWH obtained the recommended two cervical cytologies. During the different calendar intervals throughout the study period between 29-46% of WLWH followed the HIV cervical screening guidelines. Adjusted OR's of attendance to the general population screening program for WLWH aged 30, 40 and 50 years, compared to controls, were 0.69 (95% CI: 0.56-0.87), 0.67 (0.55-0.80) and 0.84 (0.61-1.15). Predictors of attendance to the HIV cervical screening program were a CD4 count > 350 cells/μL and HIV RNA < 500 copies/mL. Calendar period after 2002 and HIV RNA < 500 copies/mL predicted attendance to the general population cervical screening program.
  
  
  CONCLUSIONS
  The majority of WLWH do not follow the HIV guidelines for cervical screening. We support the idea of cytology as part of an annual review and integration of HIV care and cervical screening in a single clinic setting.
authors.affiliation: Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Kettegaards Allé 30, DK-2650 Hvidovre, Denmark. kristina.thorsteinsson@gmail.com.
authors.forename: Kristina
authors.initials: K
authors.lastname: Thorsteinsson
authors.forename: Steen
authors.initials: S
authors.lastname: Ladelund
authors.forename: Søren
authors.initials: S
authors.lastname: Jensen-Fangel
authors.forename: Terese L
authors.initials: TL
authors.lastname: Katzenstein
authors.forename: Isik Somuncu
authors.initials: IS
authors.lastname: Johansen
authors.forename: Gitte
authors.initials: G
authors.lastname: Pedersen
authors.forename: Jette
authors.initials: J
authors.lastname: Junge
authors.forename: Marie
authors.initials: M
authors.lastname: Helleberg
authors.forename: Merete
authors.initials: M
authors.lastname: Storgaard
authors.forename: Anne-Mette
authors.initials: AM
authors.lastname: Lebech
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D003718:Denmark; D055088:Early Detection of Cancer; D005260:Female; D015658:HIV Infections; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000706:statistics & numerical data*