title: Cervical screening in HIV-positive women in the East of England: recent CD4 as the predictive risk factor.
abstract: This study examines the relationship between CD4 count and cervical cytological abnormality in HIV-positive women attending two district general hospital genitourinary medicine clinics in the East of England. It aims to determine whether the rate of cervical cytological abnormalities differs in HIV-positive women with CD4 count >350 cells/µl and those with CD4 count ≤350 cells/µl; and to compare the rates of abnormalities with that of the general population. We retrospectively reviewed data from a cross-sectional audit undertaken between December 2010 and December 2011 and analysed them using multivariable statistics. There was a significant association between recent CD4 count ≤350 cells/µl and cervical cytological abnormality (p < 0.001). A total of 6.3% of women with recent CD4 counts >350 cells/µl had abnormal cervical smear results, compared with 6.6% of the general population in the screening period 2010-11 and 7.2% of the general population in the screening period 2009-10. In our study population of women with recent CD4 counts >350 cells/µl, the proportions of mild, moderate and severe dysplasia were also similar to national figures. This raises important questions about the cost effectiveness of blanket annual screening for HIV-positive women.
authors.affiliation: Department of Genitourinary medicine, Watford General Hospital, Watford, Hertfordshire, UK odavies@doctors.net.uk.
authors.forename: Olubanke
authors.initials: O
authors.lastname: Davies
authors.affiliation: Department of Genitourinary medicine, Watford General Hospital, Watford, Hertfordshire, UK.
authors.forename: Sasikala
authors.initials: S
authors.lastname: Rajamanoharan
authors.affiliation: Department of Genitourinary medicine, Luton & Dunstable Hospital NHS Foundation Trust, Luton, Bedford, UK.
authors.forename: Thambiah
authors.initials: T
authors.lastname: Balachandran
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D002584:Cervix Uteri / Q000473:pathology*; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000276:immunology* / Q000821:virology; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D065006:Papanicolaou Test; D015995:Prevalence; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: AIDS; CIN; HAART; HIV; SIL; cervical dysplasia; screening; women