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Cervical surveillance in HIV-positive women: a genitourinary medicine clinic experience
  1. Fatima W Ibrahim, MBChB, DTM…H, Specialist Registrar1,
  2. Gabriel Schembri, MRCP, Specialist Registrar1,
  3. Jyoti Dhar, MRCP, DTM…H, Consultant1,
  4. Huda Taha, MBBS, Staff Grade Doctor2 and
  5. Sati Ariyanayagam, FRCOG, FFSRH, Consultant3
  1. University Hospitals of Leicester NHS Trust, Department of Genitourinary Medicine, Leicester Royal Infirmary, Leicester, UK
  2. Department of Genitourinary Medicine, Chesterfield Royal Hospital, Calow, UK
  3. Peterborough and Stamford Hospitals NHS Foundation Trust, Department of Sexual Health, Edith Cavell Hospital, Peterborough, UK
  1. Correspondence to Dr Fatima W Ibrahim, University Hospitals of Leicester NHS Trust, Department of Genitourinary Medicine, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK. E-mail: drfwih70{at}yahoo.com

Abstract

Background The prevalence of cervical intraepithelial neoplasia (CIN) is increased in HIV infection. The UK National Health Service Cervical Screening Programme (NHSCSP) guidelines therefore provide specific recommendations for HIV-positive women. An audit of cervical surveillance in HIV-positive women who attend the genitourinary medicine (GUM) department at the Leicester Royal Infirmary, Leicester, UK was conducted. The objectives were to assess adherence to UK and local screening guidelines, prevalence of cervical pathology and appropriate referral for colposcopy.

Methods A retrospective case note review of 130 HIV-infected women attending the GUM department between January 2000 and December 2005 was undertaken.

Results Results showed that 76.2% of patients had cervical cytology within a year of HIV diagnosis and 42.4% of patients had abnormal cytology. All patients with dyskaryosis were referred for colposcopy according to local and national guidelines. Cytology results were consistent with histological findings and the prevalence of CIN was 15.2%. CD4 counts at presentation were significantly lower in those with dyskaryosis compared with those without dyskaryosis (p = 0.038). Twenty-two patients were lost to follow-up after initial cytology.

Discussion and conclusions A designated health advisor in the GUM department co-ordinates cervical surveillance in HIV-positive women. This, together with an increasingly integrated service with family planning services, may contribute to relatively successful surveillance. Overall, patients are carefully monitored to ensure that surveillance is adequate. Extra vigilance is, however, required and further cost-effective measures in future may include more active involvement of general practitioners.

  • audit
  • cervical surveillance
  • genitourinary medicine
  • HIV
  • integrated services
  • Accepted September 30, 2008.

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