Waldecker M et al evaluated how gynaecological care for women with HIV evolved over the last two decades and investigated factors associated with the uptake of gynaecological visits and cervical smears. In the present study, they included over 4000 participants of the SHCS who completed at least one gynaecological SHCS questionnaire between April 2001 and June 2022. Using mixed effects logistic regression, they assessed factors associated with uptake of gynaecological examinations and provision of cervical smears. Moreover, they calculated cervical dysplasia and cervical cancer incidence rates and used Cox proportional hazards models to identify related risk factors.
During a median follow-up of 12 years, participants had a median of 7 visits. The authors reported a cervical smear in 83% of pregnancy-unrelated visits. Interestingly, the likelihood of reporting gynaecological visits decreased in recent years, whereas the likelihood of having had a cervical smear increased over the study period. Women of older age, with a low education level, a history of injection drug use and low current CD4 cell counts were less likely to report a gynaecological visit, whereas women who reported casual sex partners were more likely. Middle-aged women and those with higher education were more likely to undergo a cervical smear, whereas women of Black ethnicity (as compared to women of White ethnicity) were less likely.
Cervical dysplasia incidence rate was 462/100,000 person-years and cervical cancer incidence was 28/100,000 person-years. Incidence for cervical dysplasia was higher in younger women, among women of Black and other ethnicities, smokers and those with lower CD4 cell counts at SHCS registration. Cervical cancer incidence was higher in those with lower CD4 cell counts.
In conclusion, the authors found disparities in gynaecological care and cervical cancer screening among women with HIV. Although the cervical cancer incidence found in this study was than the estimates from women with HIV from other European countries, it appears considerably higher than the incidence found in the general population and was far above the WHO target of 4/100,000 person-years. Integration of cervical cancer screening into HIV care could reduce the number of health care appointments, which might improve screening uptake and subsequently cancer incidence.