Abstract
BackgroundFacing the dual burden of invasive cervical cancer and HIV in sub-Saharan Africa, the identification of preventable determinants of Cervical Intraepithelial Neoplasia (CIN) in HIV-infected women is of paramount importance.MethodsA cervical cancer screening based on visual inspection methods was proposed to HIV-infected women in care in Abidjan, Côte d'Ivoire. Positively screened women were referred for a colposcopy to a gynaecologist who performed directed biopsies.ResultsOf the 2,998 HIV-infected women enrolled, 132 (4.4%) CIN of any grade (CIN+) were identified. Women had been followed-up for a median duration of three years [IQR: 1–5] and 76% were on antiretroviral treatment (ART). Their median most recent CD4 count was 452 [IQR: 301–621] cells/mm3. In multivariate analysis, CIN+ was associated with a most recent CD4 count >350 cells/mm3 (OR: 0.3; 95% CI: 0.2–0.6) or ≥200–350 cells/mm3 (OR 0.6; 95% CI 0.4–1.0) (Ref: <200 cells/mm3 CD4) (p<10−4).ConclusionsThe presence of CIN+ is less common among HIV-infected women with limited or no immune deficiency. Despite the potential impact of immunological recovery on the reduction of premalignant cervical lesions through the use of ART, cervical cancer prevention, including screening and vaccination remains a priority in West Africa while ART is rolled-out.
Highlights
Since 2002, the number of HIV-infected patients accessing to antiretroviral treatment (ART) has dramatically increased with approximately half of those eligible to ART already covered in sub-Saharan Africa in 2010 [1]
All invasive cervical cancer (ICC) are caused by an infection with a high-risk type of Human Papillomavirus (HPV) which is recognised as its necessary cofactor [4]
Study population A cervical screening program based on visual inspection of the cervix was organized in HIV clinics participating to the International epidemiological Database to Evaluate AIDS (IeDEA) West Africa collaboration in Abidjan, the economic capital of Cote d’Ivoire
Summary
Since 2002, the number of HIV-infected patients accessing to antiretroviral treatment (ART) has dramatically increased with approximately half of those eligible to ART already covered in sub-Saharan Africa in 2010 [1]. As the ART scale-up continues to improve the life expectancy of HIV-infected individuals [2], a focus on long-term case management is needed, especially in women who account for approximately two-thirds of those receiving ART in sub-Saharan Africa. According to a 2012 estimates, invasive cervical cancer (ICC) is a leading cause of cancer in women in sub-Saharan Africa with an annual incidence of 93,000 new cases and 57,000 deaths [3]. Previous reports from case-control and cohort studies have linked HIV infection with ICC and its precursors in subSaharan Africa in a time of limited access to ART [5,6,7]. Facing the dual burden of invasive cervical cancer and HIV in sub-Saharan Africa, the identification of preventable determinants of Cervical Intraepithelial Neoplasia (CIN) in HIV-infected women is of paramount importance
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