Assessing cervical intraepithelial neoplasia as an indicator disease for HIV in a low endemic setting: a...

To analyse whether the prevalence of undiagnosed HIV among (1) all women in Sweden and (2) migrant women, diagnosed with cervical intraepithelial neoplasia grade 2 or worse CIN2⁺ reaches the threshold of 0.1%, which has been suggested to be cost-effective for HIV testing.

Population-based register study.

Counties of Stockholm and Gothenburg, Sweden, 1990-2014.

All women, born between 1940 and 1990, with at least one cervical cytology or histology registered in the Swedish National Cervical Screening Register (NKCx).

Data were collected from the NKCx and the Swedish National HIV register. The proportion of women with undiagnosed HIV among women with CIN2⁺ compared with women with a normal/mildly abnormal cytology/histology was assessed.

Proportion of women with undiagnosed HIV.

The proportion of undiagnosed HIV was higher among all women with CIN2⁺ than among those without CIN2⁺ : 0.06% (95% CI 0.04-0.08) versus 0.04% (95% CI 0.04-0.04); P = 0.017). Among migrant women, the proportion of undiagnosed HIV was higher among those with CIN2⁺ than among those without [0.30% (95% CI 0.20-0.43) versus 0.08% (95% CI 0.07-0.10); P < 0.001] and exceeded 0.1%, suggesting the cost-effectiveness of HIV testing. Women with undiagnosed HIV at the time of CIN2⁺ had a significantly lower nadir CD4⁺ T-cell count, as a measure of immunosuppression, compared with women without CIN2⁺ before HIV diagnosis (median nadir CD4, 95 cells/mm³ versus 210 cells/mm³ ; P < 0.01).

HIV testing should be performed in migrant women with unknown HIV status diagnosed with CIN2⁺ .

HIV testing should be performed in migrant women with unknown HIV status diagnosed with CIN2⁺ .