Abstract
Introduction: The early detection of precancerous lesions being very important for the preventive management of cervical cancer, we felt it was important to identify these lesions on potential backgrounds including HIV-positive (HIV+) women to suggest control strategies of cervical cancer in Cameroon. Objective: To determine the prevalence of precancerous lesions in women infected with the human immunodeficiency virus (HIV), to investigate the determinants of the HIV and cervical cancer association, and to make recommendations regarding cervical cancer screening in these patients of the city of Douala. Methodology: Our study was a case-control cross-sectional study from July 2017 to December 2017 (6 months) including 108 women among which 34 HIV+ matched with 74 HIV-. HIV serology was done using the complete HIV enzygnost test. Cervical smears for cytological lesions were fixed to the cyto-fixator and then stained by the Papanicolaou technique and read under an optical microscope. The cervical smear slides for viral excretion were fixed with a methanol-acetone mixture of equal volume; HPV testing was done by the indirect immune-peroxidase technique using P16 protein. The excretion of HSV type 1 & 2 was investigated by the indirect immunofluorescence technique using the Simplex Virus type 1 & 2 Rabbit anti-Herpes from DAKO (France). Results: The two groups of women were compared with the chi square test with a significance threshold of P 0.05. The average age was 40.07 with extremes of 21 and 71 years and a standard deviation of 9.99. Of the 34 HIV+ patients, 23 had an abnormal cervix compared to 36 cases of abnormal cervix among HIV- with a statistically significant difference (P = 0.006649). 12 cases of dysplasia were observed in the 34 HIV+ women and distributed as follows: 0% of mild dysplasia, 18.92% of moderate dysplasia and 13.51% of severe dysplasia. In HIV- women we detected 6 cases of dysplasia including 1.35% of mild dysplasia, 4.05% of moderate dysplasia and 2.70% of severe dysplasia. Regarding HPV infection, we observed 21 cases of HPV among 34 HIV+ women (61.76%) against 23 cases in HIV-lesions remains high in HIV+ women, hence the need to include routine screening for precancerous lesions in all HIV+ women at all ages, as well as the routine search for HPV excretion in all those with cellular dysplasia.
Highlights
The early detection of precancerous lesions being very important for the preventive management of cervical cancer, we felt it was important to identify these lesions on potential backgrounds including human immunodeficiency virus (HIV)-positive (HIV+) women to suggest control strategies of cervical cancer in Cameroon
Invasive cervical cancer is a pathology of viral aetiology, which generally takes more than 25 years to develop, from primary infection with an oncogenic papillomavirus of genital tropism to the different grades of histological pre-cancerous lesions, reflecting the persistence of infection to invasive cancer
The data analysis revealed that abnormal cervical coloration, contact hemorrhage, and condyloma were the most common lesions in HIV+ women with a statistically significant difference compared to the control group (HIV−); concerning the coloration of the cervix (33.82% against 42.68% P = 0.006549) the contact hemorrhage (33.82% against 24.39% P = 0.00666) and the condylomas (8.82% against 2.44% P = 0.00588) [Table 4]
Summary
The early detection of precancerous lesions being very important for the preventive management of cervical cancer, we felt it was important to identify these lesions on potential backgrounds including HIV-positive (HIV+) women to suggest control strategies of cervical cancer in Cameroon. Objective: To determine the prevalence of precancerous lesions in women infected with the human immunodeficiency virus (HIV), to investigate the determinants of the HIV and cervical cancer association, and to make recommendations regarding cervical cancer screening in these patients of the city of Douala. In HIV− women we detected 6 cases of dysplasia including 1.35% of mild dysplasia, 4.05% of moderate dysplasia and 2.70% of severe dysplasia. Once mild dysplasia is identified, it usually takes between 10 and 20 years before invasive cervical cancer develops. Severe dysplasia is more likely to progress to invasive cancer, but less than 50% of cases progress to invasive cancer This percentage is even lower among young women. In the early 1990s, it appeared that precancerous lesions and invasive cervical cancer were more common and more rapid in HIV infection [2]. It is estimated that the incidence of invasive cervical cancer is about 5 to 15 times higher in HIV− infected women than in the general population [3]
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