Abstract
BackgroundCervical cancer is the third most common cancer among women worldwide, and in Nigeria it is the second most common female cancer. Cervical cancer is an AIDS-defining cancer; however, HIV only marginally increases the risk of cervical pre-cancer and cancer. In this study, we examine the risk factors for cervical pre-cancer and cancer among HIV-positive women screened for cervical cancer at two medical institutions in Abuja, Nigeria.MethodsA total of 2,501 HIV-positive women participating in the cervical cancer screen-and-treat program in Abuja, Nigeria consented to this study and provided socio-demographic and clinical information. Log-binomial models were used to calculate relative risk (RR) and 95% confidence intervals (95%CI) for the risk factors of cervical pre-cancer and cancer.ResultsThere was a 6% prevalence of cervical pre-cancer and cancer in the study population of HIV-positive women. The risk of screening positivity or invasive cancer diagnosis reduced with increasing age, with women aged 40 years and older having the lowest risk (RR=0.4; 95%CI=0.2–0.7). Women with a CD4 count of 650 per mm3 or more also had lower risk of screening positivity or invasive cancer diagnosis (RR=0.3, 95%CI=0.2–0.6). Other factors such as having had 5 or more abortions (RR=1.8, 95%CI=1.0–3.6) and the presence of other vaginal wall abnormalities (RR=1.9, 95%CI=1.3–2.8) were associated with screening positivity or invasive cancer diagnosis.ConclusionThe prevalence of screening positive lesions or cervical cancer was lower than most previous reports from Africa. HIV-positive Nigerian women were at a marginally increased risk of cervical pre-cancer and cancer. These findings highlight the need for more epidemiological studies of cervical cancer and pre-cancerous lesions among HIV-positive women in Africa and an improved understanding of incidence and risk factors.
Highlights
Cervical cancer is the third most common cancer among women worldwide, and in Nigeria it is the second most common female cancer
Results of visual inspection with acetic acid testing (VIA) or visual inspection with Lugol’s iodine (VILI) were classified according to the International Agency for Research Against Cancer (IARC) manual and recorded after each test [24]
We found the risk for cervical pre-cancer and cancer to be associated with age (≥40 years) which supports the natural history of cervical carcinogenesis from high-risk human papillomavirus (hrHPV) infection through cervical dysplasia, pre-cancer and cancer; having five or more abortions and the presence of vaginal wall abnormalities suggesting a generalized increased risk of sexually transmitted diseases in women who have cervical pre-cancer and cancer
Summary
Cervical cancer is the third most common cancer among women worldwide, and in Nigeria it is the second most common female cancer. We examine the risk factors for cervical pre-cancer and cancer among HIV-positive women screened for cervical cancer at two medical institutions in Abuja, Nigeria. In Nigeria, it is the second most common female cancer after breast cancer, with an age standardized incidence rate of 34.5 cases per 100,000 women in 2010 [3]. In addition to hrHPV, other factors impact progression, from persistent hrHPV infection to cervical pre-cancer to cancer. These include smoking, parity, education, diet, physical inactivity, sexual behavior and use of oral contraceptives [6,7]. Other factors, including population growth and aging, are contributing to the rising burden of cervical cancer in developing countries [8]
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