title: Assessing cervical intraepithelial neoplasia as an indicator disease for HIV in a low endemic setting: a population-based register study.
abstract: OBJECTIVE
  To analyse whether the prevalence of undiagnosed HIV among (1) all women in Sweden and (2) migrant women, diagnosed with cervical intraepithelial neoplasia grade 2 or worse CIN2+reaches the threshold of 0.1%, which has been suggested to be cost-effective for HIV testing.
  
  
  METHODS
  Population-based register study.
  
  
  METHODS
  Counties of Stockholm and Gothenburg, Sweden, 1990-2014.
  
  
  METHODS
  All women, born between 1940 and 1990, with at least one cervical cytology or histology registered in the Swedish National Cervical Screening Register (NKCx).
  
  
  METHODS
  Data were collected from the NKCx and the Swedish National HIV register. The proportion of women with undiagnosed HIV among women with CIN2+compared with women with a normal/mildly abnormal cytology/histology was assessed.
  
  
  METHODS
  Proportion of women with undiagnosed HIV.
  
  
  RESULTS
  The proportion of undiagnosed HIV was higher among all women with CIN2+than among those without CIN2+: 0.06% (95% CI 0.04-0.08) versus 0.04% (95% CI 0.04-0.04); P = 0.017). Among migrant women, the proportion of undiagnosed HIV was higher among those with CIN2+than among those without [0.30% (95% CI 0.20-0.43) versus 0.08% (95% CI 0.07-0.10); P < 0.001] and exceeded 0.1%, suggesting the cost-effectiveness of HIV testing. Women with undiagnosed HIV at the time of CIN2+had a significantly lower nadir CD4+T-cell count, as a measure of immunosuppression, compared with women without CIN2+before HIV diagnosis (median nadir CD4, 95 cells/mm3versus 210 cells/mm3; P < 0.01).
  
  
  CONCLUSIONS
  HIV testing should be performed in migrant women with unknown HIV status diagnosed with CIN2+.
  
  
  CONCLUSIONS
  HIV testing should be performed in migrant women with unknown HIV status diagnosed with CIN2+.
authors.affiliation: Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.|Centre for Clinical Research, Västmanland County Hospital, Västerås, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Carlander
authors.affiliation: Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Marrone
authors.affiliation: Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.|Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Brännström
authors.affiliation: Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Yilmaz
authors.affiliation: CLINTEC, Department of Obstetrics and Gynaecology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Elfgren
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Sparén
authors.affiliation: Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.|Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Sönnerborg
mesh_terms: D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000821:virology*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology
keywords: Cervical intraepithelial neoplasia; HIV; indicator disease; migrants