Almost a quarter of HIV-positive women in the US did not have an annual check-up for cervical cancer, investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes.
There are higher rates of human papilloma virus infection in HIV-positive women than the general population. Infection with some strains of human papilloma virus can lead to an increased risk of cervical and anal cancer.
Cervical cancer can be prevented, and if it develops, successfully treated. Therapy for cervical cancer is most likely to be effective if the cancer is diagnosed in its early stages. Since 1995, US HIV care guidelines have stated that HIV-positive women should have two Papanicolaou (Pap) smear tests in the first year after their HIV diagnosis and annual tests thereafter.
To see if cervical cancer screening was being performed as recommended, US investigators assessed the prevalence of Pap smear tests in the previous year amongst 2417 HIV-positive women. Factors associated with Pap tests not being performed were also assessed.
The women in the study were interviewed between 2000 and 2004 and lived in 18 US states. The majority (69%) were African American and 15% were Hispanic. The median age was 39 years. Poverty was widespread with 55% of women reporting an annual income below $10,000 per year. However, 83% had private health insurance and 74% said that their HIV care was provided by a community or public clinic.
Despite guidelines stating that HIV-positive women should have at least one Pap test per year, 556 women (23%) reported that they had not had such a test in the year before participating in the study.
Increasing age was one of the factors associated with not having a Pap test (adjusted odds ratio [AOR] = 1.3 per ten years, CI: 1.1 -1.4). Furthermore, women who reported not having a Pap test were more likely to have a CD4 cell count below 200 cells/mm3 (AOR = 1.6, CI:1.2-2.1).
Where women accessed gynaecological services was significantly associated with the chances of them having a Pap test. The group least likely to have such a test were Hispanic women who had their last pelvic examination at a location other than their regular HIV clinic (AOR = 4.8, 95% CI: 2.7-8.4). But this was also the case for white women (AOR = 2.3, 95% CI: 1.8 – 2.9) and African American women (AOR = 2.1, 95% CI: 1.1-4.1).
“Nearly a quarter of HIV-infected women in our study population had not received the recommended cervical cancer screening”, comment the investigators.
Indeed, they believe that this could be an underestimate. They note that nearly all the women in their study were receiving HIV-related care. HIV-positive women not in receipt of HIV care are even less likely to receive such screening. In addition, women over-report cervical screening by as much as a third. Furthermore, the investigators note that a third of the women in the study had been diagnosed with HIV for less than a year, and that these women should therefore have received two Pap tests in the previous year. However, these individuals did not report an increased prevalence of screening.
“HIV care providers should ensure that cervical cancer screening is performed twice in the year after diagnosis and annually thereafter, being particularly alert to ensuring Pap tests for women of increasing age, women with low CD4 cell counts, and women who receive their gynaecological care at a location other than their usual source of HIV care”, conclude the investigators.
Oster AM et al. Prevalence of cervical cancer screening of HIV-infected women in the United States. J Acquir Immune Defic Syndr (online edition), 2009.