Sexual behavior, cervical cancer screening and vaccine uptake in HIV-infected adolescents & young adults

Background. Human papillomavirus (HPV) infection is widely accepted as a necessary for the development of invasive cervical cancer - the primary gynecological manifestation of human immunodeficiency virus (HIV) infection. Strategies available for reducing the risk of HPV infection and cervical cancer among youth include reducing high risk sexual behavior, cervical Pap screening and vaccination.;Methods. The first study describes the sexual behavior of HIV infected youth; determines correlates of sexual activity among youth with perinatally-acquired HIV infection and compares sexual risk behavior in youth with perinatally-acquired HIV infection (PHI) versus behaviorally-acquired HIV infection (BHI). The second study determines the prevalence of cervical Pap screening (CPAP-S); examines factors associated with CPAP-S and explores risk factors for abnormal cervical cytology among sexually active HIV-infected females 13-24 years of age. The third study examines factors affecting uptake of the meningococcal conjugate vaccine (MCV4) and the combined tetanus, inactivated diphtheria & acellular pertussis (Tdap) vaccine as a proxy for HPV vaccine uptake among HIV-infected adolescents.;Results. Study 1: 34% of PHI youth were sexually active in 2006. Increasing age, having a boyfriend/girlfriend and illicit drug use were associated with sexual activity in PHI youth. Sexually active PHI (compared to BHI) youth were less likely to have been diagnosed with an STI in 2006.;Study 2. CPAP-S among sexually active HIV-infected females was low (49%) and more than half (58%) of Pap tests were abnormal. Perinatal HIV infection and black race were associated with decreased likelihood of CPAP-S. CD4 nadir counts of <200 cells/mol and previous STIs were associated with increased likelihood of an abnormal cervical cytology report. Study 3. MCV4 and Tdap vaccine coverage among HIV-infected youth in 2006 was low. PHI youth were significantly more likely to have received MCV4 or Tdap vaccines compared to BHI youth.;CONCLUSIONS. Our findings add to evidence of sexual activity among PHI youth. It also provides valuable insight on CPAP-S and vaccine uptake among in HIV-infected youth. Findings from this research may have implications for the prevention of HPV infection and cervical cancer among PHI youth as they mature into young adults.