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Open Access Research article

Adherence to the cervical cancer screening program in women living with HIV in Denmark: comparison with the general population

Kristina Thorsteinsson1*, Steen Ladelund2, Søren Jensen-Fangel3, Terese L Katzenstein4, Isik Somuncu Johansen5, Gitte Pedersen6, Jette Junge7, Marie Helleberg4, Merete Storgaard3 and Anne-Mette Lebech1

Author Affiliations

1 Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Kettegaards Allé 30, DK-2650 Hvidovre, Denmark

2 Clinical Research Center, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark

3 Department of Infectious Diseases, Skejby, Aarhus University Hospital, Skejby, Denmark

4 Department of Infectious Diseases, The National University Hospital, Rigshospitalet, Copenhagen, Denmark

5 Department of Infectious Diseases, Odense University Hospital, Odense, Denmark

6 Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark

7 Department of Pathology, Hvidovre, Copenhagen University Hospital, Hvidovre, Denmark

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BMC Infectious Diseases 2014, 14:256  doi:10.1186/1471-2334-14-256

Published: 13 May 2014

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.

Keywords:
Cervical; Cancer; Screening; HIV; Adherence; Attendance; Guidelines