Association between invasive cancer of the cervix and HIV-1 infection in Tanzania: the need for dual screening

Crispin Kahesa,Twalib Ngoma,Charles As Karamagi,Joan N Kalyango,Julius Mwaiselage,Henry R Wabinga

doi:10.1186/1471-2458-8-262

Crispin Kahesa, Twalib Ngoma + Show 4 more

Open Access

https://doi.org/10.1186/1471-2458-8-262

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Abstract

BackgroundCancer of the cervix is the second commonest malignancy in females worldwide and is the leading malignancy among women in Tanzania. Cancer of the cervix has been strongly associated with Human Papilloma Virus (HPV) which is a sexually transmitted disease. However, the role of HIV-1 in the aetiology of cancer of the cervix is less clear. Studies suggest that HPV and HIV-1 infection are synergistic and therefore their dual occurrence may fuel increased incidence of cancer of the cervix and AIDS. We therefore conducted a study to determine the association between cancer of the cervix and HIV-1.MethodsThe study was carried out in Ocean Road Cancer Institute, Dar-es-salaam, Tanzania between January and March 2007. A hospital-based case control design was used to study 138 cases and 138 controls. The cases were consenting women 18 years and above with histologically confirmed squamous cell carcinoma of the cervix, while the controls were consenting non-cancer adult women attendants or visitors. The participants were counselled and tested for HIV-1 and interviewed to assess risk factors for cancer of the cervix and HIV-1. Estimation of risk was done by computing odds ratios and confidence intervals. Confounding and interaction between the factors were assessed using logistic regression.ResultsHIV-1 prevalence was much higher among the cases (21.0%) than among the controls (11.6%). In logistic regression, HIV-1 was associated with cancer of the cervix (OR = 2.9, 95% CI = 1.4–5.9). Among the cases the mean age was lower for HIV-1 infected (44.3 years) than HIV-1 uninfected women (54 years, p = 0.0001).ConclusionHIV-1 infection is associated with invasive cancer of the cervix. Resource-constrained countries with a high burden of HIV-1 and cervical cancer should adopt a high-risk approach that targets HIV-1 positive women for screening of cervical cancer initially by utilizing HIV/AIDS resources.

Highlights

Cancer of the cervix is the second commonest malignancy in females worldwide and is the leading malignancy among women in Tanzania
18 (6.5%) of the participants were from southern zone, 27 (9.8%) were from central zone, 30 (10.9%) were from southern highland, 42 (15.2%) from lake zone, 111 (40.2%) from eastern zone and 48 (17.4%) were from northern zone
The mean age (SD) of the study participants was 50.0 (12.3) years and was significantly higher among the cases compared to the controls (51.9 yrs vs. 47.4 yrs; p-value = 0.002)

Summary

Introduction

The age-standardized incidence of cervical cancer in sub-Saharan Africa is 30 to 67 per 100,000, which is two to ten times higher than that in developed countries [1]. Unlike in developed countries where the incidence of cervical cancer has declined, the incidence of cervical cancer in sub-Saharan Africa has not decreased but has even risen in some regions [1,2]. In a situational analysis for cervical cancer diagnosis and treatment in the East, Central and Southern African countries, Chirenje and colleagues found that, though 95% of health care facilities had the infrastructure for cervical screening, very few women were screened due to lack of policy guidelines, infrequent supply of basic materials, and lack of suitably qualified staff [7]

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