By Kieryn Graham
Published: Dec 23, 2011 9:33 am
Results from a recent study show high rates of abnormal Pap smear test results among sexually active, HIV-positive, female teens. More than half of the Pap test results in the study were abnormal.
The study also showed that teens with HIV acquired from their mothers during pregnancy or childbirth were significantly less likely to get Pap smear tests than teens with behaviorally-acquired HIV.
The study investigators suggested that prevention of human papillomavirus, a primary cause of cervical cancer, through vaccination may be especially beneficial among HIV-positive, female teens who acquired HIV from their mothers. They also stated that clearer guidelines on initiation and frequency of Pap screening in this population of HIV-positive women may be necessary.
HIV in women is associated with an increased risk of acquiring human papillomavirus (HPV), one of the most common sexually transmitted infections. Previous research has shown that around 75 percent to 80 percent of HIV-positive women also have HPV.
In addition, women with both HIV and HPV are at an increased risk of cervical cancer (see related AIDS Beacon news), which is primarily caused by HPV. Researchers estimate that 20 percent to 60 percent of HIV-positive women show signs of pre-cervical cancer.
Pap tests, also called pap smears, detect the presence of abnormal or cancerous cells in the cervix. According to the study authors, these tests have been shown to reduce cervical cancer rates by 60 percent to 90 percent.
Although the American Cancer Society recommends regular Pap tests for women with HIV, it does not address the timing of initial Pap screening for teens with HIV acquired from their HIV-positive mothers at birth (called perinatally-acquired HIV). Guidelines for HIV-negative women recommend screening within three years of becoming sexually active or at age 21.
According to the study authors, most patients with perinatally-acquired HIV are seldom perceived as a high-risk group for HPV infection because most of them have been cared for since infancy in pediatric clinics. However, recent studies have shown that sexual activity, sexually transmitted infections, and pregnancy in this population are common.
In this study, the researchers compared cervical cancer screening rates in teens with perinatally- versus behaviorally-acquired HIV. They also monitored rates of abnormal Pap test results in both groups.
The study included 231 sexually active HIV-positive women aged between 13 and 24 years old from 20 clinical sites across the United States. About 46 percent had perinatally-acquired HIV. Thirteen percent had a record of HPV infection, over 36 percent had a current or past sexually transmitted infection, and 52 percent were pregnant at least once between 2001 and 2006.
Results showed that 58 percent of Pap test results were abnormal. However, most of the abnormalities identified in the study were low-grade lesions. Only 2 percent of patients had high-grade lesions.
Having a sexually transmitted infection was associated with an increased likelihood of abnormal Pap test results, although the authors noted that this may be because women with sexually transmitted infections are viewed as a high-risk group by clinicians, who are thus more likely to recommend cervical cancer screening.
In addition, patients with CD4 (white blood cell) counts less than 200 cells per microliter were twice as likely to have an abnormal Pap test result.
Results also showed that less than half the participants had one or more Pap test between 2001 and 2006. Women with perinatally-acquired HIV were 34 percent less likely to have undergone Pap tests than women with behaviorally-acquired HIV. African-American women were 26 percent less likely to have undergone Pap tests compared with Caucasians. The researchers suggested that the latter may be due to socioeconomic differences.
Patients 21 years or older and patients with a history of any sexually transmitted infection or pregnancy were more likely to get a Pap smear test. Participants managed at clinics with an on-site adolescent medicine specialist were 20 percent more likely to have a Pap test and 31 percent less likely to have an abnormal Pap test result as teens managed at pediatric clinics.
Nineteen percent of abnormal Pap test results had reverted to normal by the end of the study.
For more information, please see the study in the Journal of Pediatric and Adolescent Gynecology (abstract).
No comments:
Post a Comment