Abstract
BackgroundThe prevalence of High-Risk Human papilloma virus (HR-HPV), a necessary cause of invasive cervical cancer (ICC) is relatively high in HIV infected women. Gaps exist in our knowledge of the optimal approaches for managing women who have HR-HPV with normal cervical cytology (NCC) particularly in settings of HIV infection.MethodsBetween May 2012 and June 2013 we conducted a colposcopic assessment of HIV-infected women with prior (NCC) and known HR-HPV status to compare cervical abnormalities in women with and without HR-HPV. Colposcopic examinations were done at the Operation Stop Cervical Cancer (OSCC) unit of the Jos University Teaching Hospital (JUTH), Jos, Nigeria. Abnormal colposcopic finding (ACF) was defined as areas of aceto-white epithelium involving the squamo-coulumnar junction, areas of punctation, mosaic pattern or atypical vessels. We compared proportions of ACF as well as histologic grades of cervical intra-epithelial neoplasia (CIN) in women with or without HR-HPV. Statistical analysis was done on STATA.ResultsWe conducted colposcopic examinations in 78 out of 89 (86.5%) eligible women. The mean age of the cohort was 32.4 years (SD ±4.6) with a median 32 years (IQR 29–36). After a mean follow up time of 20.1 months from the initial cervical pap cytology and HR-HPV testing, we found 12 of 78 (15.4%) women with ACF. The odds for an ACF was statistically higher [OR = 4.0 (95% CI: 1.1-14.7)] in women with HR-HPV compared to those without. Of the twelve women with ACF, subsequent histologic examination of colposcopically directed cervical biopsies confirmed CIN 1 in 4 cases (33.3%), CIN 2 in 1 case (8.3%), CIN 3 in 2 cases (16.7%), carcinoma-in-situ (CIS) in 2 cases (16.7%), and normal cervix in 3 (25.0%). Overall, the proportion of women detected with any grade of CIN was 11.5% (9/78) and 6.4% (5/78) were CIN 2 or greater lesion (CIN2+).ConclusionHIV-infected women with NCC and HR-HPV had a four-fold higher likelihood for an ACF. The practice of early colposcopic examination of HIV-infected women with prior NCC and HR-HPV may increase early detection of higher grade CIN and CIS cancer stages in our setting.
Highlights
Cervical cancer was responsible for up to 25.4% of all new cancer cases in women in sub-Saharan Africa in 2012 [1]
Studies have demonstrated the effectiveness of High-Risk Human papilloma virus (HR-HPV) DNA testing in detecting high-grade squamous intraepithelial lesions and prevention of invasive cervical cancer cases compare to cervical cytology [9,10,11,12]
The proportion of women detected with any grade of cervical intra-epithelial neoplasia (CIN) was 11.5% (9/78) and CIN2+ was 6.4% (5/78) in our cohort
Summary
Cervical cancer was responsible for up to 25.4% of all new cancer cases in women in sub-Saharan Africa in 2012 [1]. In developed countries of the world, well-organized cervical cancer screening programs using Pap smear cytology has led to significant declines in invasive cervical cancer. Such national programs do not exist in most developing countries like Nigeria. Studies have demonstrated the effectiveness of HR-HPV DNA testing in detecting high-grade squamous intraepithelial lesions and prevention of invasive cervical cancer cases compare to cervical cytology [9,10,11,12]. The utility of HR-HPV DNA testing as a cervical cancer prevention strategy has demonstrated significant reduction in cervical cancer mortality compare to conventional Pap cytology in resource limited countries [13]. Gaps exist in our knowledge of the optimal approaches for managing women who have HR-HPV with normal cervical cytology (NCC) in settings of HIV infection
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
