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ICRC-Models / HHCoM

Compartmental model of HIV and HPV heterosexual transmission, development of AIDS and cervical cancer, and interventions
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Sexual activity of women with cervical cancer and end-stage HIV #58

Closed carajbro closed 4 years ago

carajbro commented 5 years ago

Should assume that people with cervical cancer continue to be sexually active and transmit infection? We previously assumed they did, but I remember from a meeting with Ruanne that she thought they didn’t because sex would be too painful.

This is relevant because it determines whether I should continue to track the progression/clearance of HPV infections of the other type once someone gets cervical cancer.

carajbro commented 5 years ago

Darcy: My intuition is that, as Ruanne says, they will probably decrease their sexual activity. But, if treatment is available, I don’t think sexual activity would go down to zero. I just found a study in Sweden that surveyed women who had been treated for CC and found that 68% of women with a history of CC reported regular vaginal intercourse (https://www.nejm.org/doi/full/10.1056/nejm199905063401802). This study also found decreased sexual activity, but women are still having sex: https://www-sciencedirect-com.offcampus.lib.washington.edu/science/article/pii/S0360301603003626. This study and this one measured quality of life and sexual functioning among women treated for cervical cancer compared to the general population and found lower sexual functioning, including more pain during sex. This is particularly true to women treated with radiotherapy - those treated with surgery alone have fewer complications.

So I think it would be good to continue to track the other HPV type. And we’d want to adjust assumptions about coital frequency and partnership formation for women with CC.

carajbro commented 5 years ago

A lot of the literature looks at women with CC who have been treated, but it does seem that women with CC (regardless of treatment) are having sex. Will need to adjust number of acts/partnerships in the future.

darcyrao commented 5 years ago

Okay let me know if I can help look up data for this. We could set it to be pretty low for untreated women.

darcyrao commented 4 years ago

Current proposal: reduce the HIV and HPV transmission probabilities for women with cervical cancer and for men and women in end-stage HIV as a proxy for reduced sexual behavior. As noted in issue #49, changing sexual behavior would have implications for mixing that we'd need to think through in more detail -- as the epidemic trajectories change over time, there would be changes in mixing and adjustments made to get the matrices to balance that we will want to think through more carefully.

carajbro commented 4 years ago

We could assume that cervical cancer and end-stage HIV decrease both HPV and HIV transmission by half since that's what we assume right now for reduction in HIV transmission during late-stage.

...might want to vary this by CC stage though.

carajbro commented 4 years ago

Slides on effect of late-stage HIV transmission multiplier