Abstract
BackgroundThe burden of cervical cancer remains huge globally, more so in sub-Saharan Africa. Effectiveness of screening, rates of recurrence following treatment and factors driving these in Africans have not been sufficiently studied. The purpose of this study therefore was to investigate factors associated with recurrence of cervical intraepithelial lesions following thermo-coagulation in HIV-positive and HIV-negative Nigerian women using Visual Inspection with Acetic Acid (VIA) or Lugol’s Iodine (VILI) for diagnosis.MethodsA retrospective cohort study was conducted, recruiting participants from the cervical cancer “see and treat” program of IHVN. Data from 6 sites collected over a 4-year period was used. Inclusion criteria were: age ≥18 years, baseline HIV status known, VIA or VILI positive and thermo-coagulation done. Logistic regression was performed to examine the proportion of women with recurrence and to examine factors associated with recurrence.ResultsOut of 177 women included in study, 67.8 % (120/177) were HIV-positive and 32.2 % (57/177) were HIV-negative. Recurrence occurred in 16.4 % (29/177) of participants; this was 18.3 % (22/120) in HIV-positive women compared to 12.3 % (7/57) in HIV-negative women but this difference was not statistically significant (p-value 0.31). Women aged ≥30 years were much less likely to develop recurrence, adjusted OR = 0.34 (95 % CI = 0.13, 0.92). Among HIV-positive women, CD4 count <200cells/mm3 was associated with recurrence, adjusted OR = 5.47 (95 % CI = 1.24, 24.18).ConclusionRecurrence of VIA or VILI positive lesions after thermo-coagulation occurs in a significant proportion of women. HIV-positive women with low CD4 counts are at increased risk of recurrent lesions and may be related to immunosuppression.
Highlights
The burden of cervical cancer remains huge globally, more so in sub-Saharan Africa
We conducted an analysis of de-identified data of women who participated in the cervical cancer “see and treat” program of the Institute of Human Virology Nigeria (IHVN) that was implemented in collaboration with 6 hospitals—National Hospital Abuja (NHA), University of Abuja Teaching Hospital (UATH), Garki Hospital Abuja (GHA), Federal Medical Centre Keffi (FMCK), Aminu
Out of a total of 5190 women screened by Visual Inspection with Acetic Acid (VIA) or visual inspection with Lugol’s iodine (VILI) over a 4-year period, the proportion of VIA/VILI positive lesions was 7.7 % (398/5190); this was 8.3 % (265/3212) for human immunodeficiency virus (HIV)-positive women and 6.7 % (133/1978) for HIVnegative women (p-value 0.05), see Table 1 and Fig. 1
Summary
The burden of cervical cancer remains huge globally, more so in sub-Saharan Africa. The purpose of this study was to investigate factors associated with recurrence of cervical intraepithelial lesions following thermo-coagulation in HIV-positive and HIV-negative Nigerian women using Visual Inspection with Acetic Acid (VIA) or Lugol’s Iodine (VILI) for diagnosis. In Sub-Saharan Africa the prevalence of HIV and cervical cancer are high. In Nigeria, the Age Standardized Incidence Rate (ASR) of cervical cancer was 34.5 per 100,000 in 2011, making it the second most common cancer in the country [12] and there were 3.2 million people living with HIV in 2013 (2nd highest globally) [13]. Treatment of high grade CIN using excisional or ablative methods are efficacious and substantially reduces risk of cervical cancer they can be followed by recurrent disease [16]
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