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Assessing cervical intraepithelial neoplasia as an indicator disease for HIV in a low endemic setting: a population‐based register study
Author(s) -
Carlander C,
Marrone G,
Brännström J,
Yilmaz A,
Elfgren K,
Sparén P,
Sönnerborg A
Publication year - 2017
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.14614
Subject(s) - medicine , cervical intraepithelial neoplasia , population , cytology , gynecology , immunosuppression , cervical screening , demography , cervical cancer , obstetrics , cancer , pathology , environmental health , sociology
Objectives 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 CIN 2 + reaches the threshold of 0.1%, which has been suggested to be cost‐effective for HIV testing. Design Population‐based register study. Setting Counties of Stockholm and Gothenburg, Sweden, 1990–2014. Population All women, born between 1940 and 1990, with at least one cervical cytology or histology registered in the Swedish National Cervical Screening Register ( NKC x). Methods Data were collected from the NKC x and the Swedish National HIV register. The proportion of women with undiagnosed HIV among women with CIN 2 + compared with women with a normal/mildly abnormal cytology/histology was assessed. Main outcome measures Proportion of women with undiagnosed HIV . Results The proportion of undiagnosed HIV was higher among all women with CIN 2 + than among those without CIN 2 + : 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 CIN 2 + 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 CIN 2 + had a significantly lower nadir CD 4 + T‐cell count, as a measure of immunosuppression, compared with women without CIN 2 + before HIV diagnosis (median nadir CD 4, 95 cells/mm 3 versus 210 cells/mm 3 ; P < 0.01). Conclusions HIV testing should be performed in migrant women with unknown HIV status diagnosed with CIN 2 + . Tweetable abstract HIV testing should be performed in migrant women with unknown HIV status diagnosed with CIN 2 + .