How best to screen for cervical cancer

A study recruited nearly 10 000 women attending one of 26 sexually transmitted infection clinics, family planning clinics, or primary care clinics in six US cities between 2003 and 2005 for routine cervical cancer screening. Two specimens were taken from each woman. One specimen was examined cytologically, and the other was tested for high risk human papillomavirus (HPV) DNA using two different methods.

Overall, 23% of women were positive for high risk HPV DNA. High risk HPV DNA was found in 9% of women aged 30 or more and in 22% of women younger than 30 who had normal smear results. It is unclear how to interpret this discrepancy, and what to do next with these women.

The linked editorial (p 557) discusses these and other concerns, and it concludes that doctors still need to choose which tests to use. Doctors who decide to use both cytology and HPV DNA screening—in an attempt to prolong the safe gap between screens to at least three years—face new challenges in supporting the information they give to patients by solid evidence.

Two HIV drugs linked to increased risk of myocardial infarction

An observational study of 33 347 people with HIV assessed the association between the occurrence of myocardial infarction and treatment with nucleoside reverse transcriptase inhibitors—zidovudine, didanosine, stavudine, lamivudine, and abacavir. The rates of myocardial infarction were increased with recent use of abacavir (relative rate 1.90, 95% CI 1.47 to 2.45; P<0.001) or didanosine (1.49, 1.14 to 1.95; P=0.003). But rates were no higher in people who had stopped taking abacavir or didanosine six or more months ago than in those who never took the drug⇑.

In an accompanying letter (doi: 10.1016/S0140-6736(08)60492-4), employees of GlaxoSmithKline—the manufacturer of abacavir—briefly present pooled data from 54 clinical trials, which included nearly 15 000 people with HIV. These data show no increased risk for myocardial infarction with abacavir, …