Self-reported history of Pap-smear in HIV-positive women in Northern Italy: a cross-sectional studyReportar como inadecuado

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BMC Cancer

, 10:310

First Online: 21 June 2010Received: 25 September 2009Accepted: 21 June 2010DOI: 10.1186-1471-2407-10-310

Cite this article as: Dal Maso, L., Franceschi, S., Lise, M. et al. BMC Cancer 2010 10: 310. doi:10.1186-1471-2407-10-310


BackgroundThe incidence of invasive cervical cancer in HIV-positive women is higher than in the general population. There is evidence that HIV-positive women do not participate sufficiently in cervical cancer screening in Italy, where cervical cancer is more than 10-fold higher in women with AIDS than in the general population. The aim of the present study was to evaluate the history of Pap-smear in HIV-positive women in Italy in recent years. We also examined the sociodemographic, clinical, and organizational factors associated with adherence to cervical cancer screening.

MethodsA cross-sectional study was conducted between July 2006 and June 2007 in Emilia-Romagna region Northern Italy. All HIV-positive women who received a follow-up visit in one of the 10 regional infectivology units were invited to participate. History of Pap-smear, including abnormal smears and subsequent treatment, was investigated through a self-administered anonymous questionnaire. The association between lack of Pap-smear in the year preceding the interview and selected characteristics was assessed by means of odds ratios OR and 95% confidence intervals adjusted for study centre and age.

ResultsA total of 1,002 HIV-positive women were interviewed. Nine percent reported no history of Pap-smear, and 39% had no Pap-smear in the year prior to the date of questionnaire last year. The lack of Pap-smear in the last year was significantly associated with age <35 years OR = 1.4, compared to age ≥45 years, lower education level OR = 1.3, first HIV-positive test in the last 2 years OR = 1.4, and CD4 count <200 cells-μl OR = 1.6. Conversely, when women were advised by a gynecologist rather than other health workers to undergo screening, it significantly increased adherence. Non-significantly higher proportions of lack of Pap-smear in the last year were found in women born in Central-Eastern Europe OR = 1.8 and Africa OR = 1.3. No difference in history of Pap-smear emerged by mode of HIV-acquisition or AIDS status.

Three hundred five 34% women reported a previous abnormal Pap-smear, and of the 178 58% referred for treatment, 97% complied.

ConclusionsIn recent years the self-reported history of Pap-smear in HIV-positive women, in some public clinics in Italy, is higher than previously reported, but further efforts are required to make sure cervical cancer screening is accessible to all HIV-positive women.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2407-10-310 contains supplementary material, which is available to authorized users.

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Autor: Luigino Dal Maso - Silvia Franceschi - Mauro Lise - Priscilla Sassoli de- Bianchi - Jerry Polesel - Florio Ghinelli - Fabio


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