Evidence map›Paper›PMID 23842133›Full record

ArticleAIDS (London, England)2013

Comparing Papanicolau smear, visual inspection with acetic acid and human papillomavirus cervical cancer screening methods among HIV-positive women by immune status and antiretroviral therapy.

Michael H Chung, Kevin P McKenzie, Hugo De Vuyst, Barbra A Richardson, Farzana Rana, Ritesh Pamnani, Julia W Njoroge, Evans Nyongesa-Malava, Samah R Sakr, Grace C John-Stewart and 1 more

Open access · greenAbstract readComparative StudyEvaluation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in AIDS (London, England), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
40citing papers in PubMed, 5 pooled it
3.3field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

40 citing papers in PubMed, 5 syntheses or guidelines pooled it, 64 citations in OpenAlex.

  1. Pooled it
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  3. Carcinogenicity of Human Papillomavirus (HPV) Types in HIV-Positive Women: A Meta-Analysis From HPV Infection to Cervical Cancer.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2017
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 6 institutions in 4 countries.

Michael H ChungaDepartment of Global Health bDepartment of Medicine cDepartment of Epidemiology dDepartment of Biostatistics, University of Washington, Seattle, Washington, USA eInfections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France fVaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA gAga Khan University Hospital hKenyatta National Hospital iCoptic Hospital, Nairobi, Kenya. *Deceased.
Kevin P McKenzie
Hugo De Vuyst
Barbra A Richardson
Farzana Rana
Ritesh Pamnani
Julia W Njoroge
Evans Nyongesa-Malava
Samah R Sakr
Grace C John-Stewart
Nelly R Mugo
Kenyatta National Hospital · KEAga Khan University Hospital · PKCentre International de Recherche sur le Cancer · FRFred Hutch Cancer Center · USGTx (United States) · USNairobi Hospital · KE

Funding

Pediatric HIV-1 in Africa: Pathogenesis and ManagementK24HD054314 · NICHD · UNIVERSITY OF WASHINGTON · PI JOHN-STEWART, GRACE C. · 2006 to 2016
$1.2M
HAART Adherence Interventions in Africa: an RCTK23AI065222 · NIAID · UNIVERSITY OF WASHINGTON · PI CHUNG, MICHAEL HOONBAE · 2005 to 2009
$639k
NIAID NIH HHS K23 AI065222NIAID NIH HHS K23-AI065222-04NICHD NIH HHS 1K24HD054314-04NICHD NIH HHS K24 HD054314PEPFARPHS HHS U62/CCU024512-04
6 · The paper itself

Abstract

backgroundA rigorous comparison of cervical cancer screening methods utilizing data on immune status, antiretroviral therapy (ART) and colposcopy-directed biopsy has not been performed among HIV-positive women.

methodsBetween June and November 2009, 500 HIV-positive women were enrolled at an HIV treatment clinic in Nairobi, Kenya, and underwent Papanicolau (Pap) smear, visual inspection with acetic acid (VIA), human papillomavirus (HPV) and colposcopy-directed biopsy (gold standard). Positive Pap smear (ASCUS+, LSIL+, HSIL+), VIA, HPV and their combinations were compared with CIN2/3+. Sensitivity, specificity and AUC (sensitivity and 1-specificity) were compared using pairwise tests and multivariate logistic regression models that included age, CD4⁺ cell count and ART duration.

resultsOf 500 enrolled, 498 samples were collected. On histology, there were 172 (35%) normal, 186 (37%) CIN1, 66 (13%) CIN2, 47 (9%) CIN3 and 27 (5%) indeterminate. Pap (ASCUS+) was the most sensitive screening method (92.7%), combination of both Pap (HSIL+) and VIA positive was the most specific (99.1%) and Pap (HSIL+) had the highest AUC (0.85). In multivariate analyses, CD4⁺ cell count of 350 cells/μl or less was associated with decreased HPV specificity (P = 0.002); ART duration of less than 2 years was associated with decreased HPV (P = 0.01) and VIA (P = 0.03) specificity; and age less than 40 years was associated with increased VIA sensitivity (P < 0.001) and decreased HPV specificity (P = 0.005).

conclusionPap smear is a robust test among HIV-positive women regardless of immune status or ART duration. Results should be cautiously interpreted when using HPV among those younger, immunosuppressed or on ART less than 2 years, and when using VIA among those aged 40 years or more.

Indexed as

AdolescentAdultAge FactorsAnti-Retroviral AgentsBiopsyCD4 Lymphocyte CountColposcopyEarly Detection of CancerFemaleHistocytochemistryHIV InfectionsHumansKenyaMiddle AgedPapanicolaou TestPapillomavirus InfectionsAnti-Retroviral Agents

Identifiers

PMID23842133
PMCPMC4007364
OpenAlexW2072280350

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.