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1.
BJOG ; 124(10): 1585-1593, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28120382

ABSTRACT

OBJECTIVE: To compare the results from an initial negative human papillomavirus (HPV) test with re-screening after 3 years in women attending two HPV-based screening programmes. DESIGN: Population-based cohort study. SETTING: Two cervical service screening programmes in Italy. POPULATION: Women aged 25-64 years invited to screening from April 2009 to October 2015. METHODS: Eligible women were invited to undergo an HPV test. Those with a negative HPV test went on to the next screening round 3 years later. Cytology triage was performed for HPV+ (HPV by Hybrid Capture 2) samples, with immediate colposcopy (if abnormal) and HPV re-testing 1 year later (if negative). MAIN OUTCOME MEASURES: Participation rate, positivity at HPV and at triage, referral rate to colposcopy, positive predictive value for cervical intraepithelial neoplasia grade 2+ (CIN2+) at colposcopy, and detection rate for CIN2+. RESULTS: We present the results from 48 751 women at the first screening and 22 000 women at re-screening 3 years later. The response rate was slightly higher at the second screening (74.5 versus 72.1% at the first screening; referral rate, RR 1.11; 95% confidence interval, 95% CI, 1.07-1.14). Compared with the first screening, we observed a significant reduction at the second screening in terms of HPV positivity (RR 0.55, 95% CI 0.51-0.60), referral rate to colposcopy (RR 0.47, 95% CI 0.41-0.53), CIN2+ detection rate (RR 0.24, 95% CI 0.13-0.39), and positive predictive value (PPV) for CIN2+ at colposcopy (RR 0.51, 95% CI 0.29-0.87). CONCLUSIONS: The very low frequency of disease and inadequate PPV at colposcopy indicate that a 3-year interval after a negative HPV test is too short. TWEETABLE ABSTRACT: Three years after a negative HPV the frequency of cervical disease is so low that re-screening is inefficient.


Subject(s)
Early Detection of Cancer/statistics & numerical data , Mass Screening/statistics & numerical data , Papillomavirus Infections/diagnosis , Time Factors , Uterine Cervical Neoplasms/diagnosis , Adult , Cervix Uteri/virology , Cohort Studies , Colposcopy/statistics & numerical data , Early Detection of Cancer/methods , Female , Humans , Mass Screening/methods , Middle Aged , Papillomaviridae , Papillomavirus Infections/complications , Predictive Value of Tests , Referral and Consultation/statistics & numerical data , Uterine Cervical Neoplasms/virology , Vaginal Smears/statistics & numerical data
3.
Eur J Med Res ; 15(2): 81-3, 2010 Feb 26.
Article in English | MEDLINE | ID: mdl-20452889

ABSTRACT

BACKGROUND: In HIV-infected patients with HCV-related chronic hepatitis, liver impairment and drug toxicity may substantially reduce the number of possible therapeutic options. CASE DESCRIPTION: we here describe the case of an HCV-HIV coinfected woman who had repeated severe episodes of drug-related liver toxicity with indinavir, saquinavir, fosamprenavir, and darunavir, with minimal further therapeutic options left in this class. Previous treatment-limiting side effects with efavirenz and nevirapine also precluded use of non-nucleoside reverse transcriptase inhibitors. Introduction of an integrase-inhibitor regimen based on raltegravir, tenofovir, and emtricitabine allowed a prompt achievement of undetectable viral load and a substantial rise of CD4 count to high levels, with no subsequent episodes of hepatic toxicity, and no other side effects. CONCLUSIONS: given the relatively common prevalence of HCV-related chronic hepatitis among people with HIV, raltegravir might represent an important alternative option for a substantial number of patients who cannot be treated with protease inhibitors or NNRTI because of drug-related hepatic toxicity.


Subject(s)
Adenine/analogs & derivatives , Antiviral Agents/therapeutic use , Chemical and Drug Induced Liver Injury/etiology , Deoxycytidine/analogs & derivatives , HIV Infections/drug therapy , Hepatitis C, Chronic/drug therapy , Organophosphonates/therapeutic use , Protease Inhibitors/adverse effects , Pyrrolidinones/therapeutic use , Adenine/therapeutic use , Adult , CD4-Positive T-Lymphocytes/drug effects , CD4-Positive T-Lymphocytes/pathology , Chemical and Drug Induced Liver Injury/pathology , Deoxycytidine/therapeutic use , Drug Therapy, Combination , Emtricitabine , Female , HIV Infections/complications , Hepatitis C, Chronic/complications , Humans , Liver/drug effects , Liver/pathology , Lymphocyte Count , Raltegravir Potassium , Tenofovir , Treatment Outcome , Viral Load/drug effects
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