Human Immunodeficiency Virus Negative Women Research Articles

The risk of mother-to-child transmission of hepatitis B virus infection in Ethiopia: A systematic review and meta-analysis.

Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is a predominant route of infection for children in Ethiopia. No study has so far reported a nationwide estimate of the risk of MTCT of HBV. We conducted a meta-analysis of surveys and estimated the pooled risk of MTCT of HBV in the context of human immunodeficiency virus (HIV) infection. We searched PubMed, EMBASE, Web of Science, Africa Index Medicus, and Google Scholar databases for peer-reviewed articles. The pooled risk of MTCT of HBV was estimated using the DerSimonian-Laird technique with logit transformed proportions and statistical heterogeneity was estimated using I2 statistic, which was explored by subgroup and meta-regression analyses. The overall pooled risk of MTCT of HBV in Ethiopia was 25.5% (95% CI, 13.4%-42.9%). In women without HIV infection, the risk of MTCT of HBV was 20.7% (95% CI 2.8%-70.4%), and 32.2% (95% CI 28.1%-36.7%) in women with HIV infection. After excluding the outlier study, the risk of MTCT of HBV in studies that included only HIV negative women was 9.4% (95% CI, 5.1%-16.6%). The risk of MTCT of HBV in Ethiopia widely varied by HBV/HIV coinfection. A sustainable control and elimination of HBV in Ethiopia requires improved access to birth-dose HBV vaccine and implement immunoglobulin prophylaxis for exposed infants. Given the limited health resources in Ethiopia, prenatal antiviral prophylaxis integrated with antenatal care may be a cost-effective approach to significantly reduce the risk of MTCT of HBV.

Effects of HIV Infection on Pregnancy Outcomes Among Women Attending Antenatal Care in Referral Hospitals of the Amhara Regional State, Ethiopia: A Prospective Cohort Study.

BackgroundHuman immunodeficiency virus (HIV) has remained to be a significant public health problem worldwide mainly affecting women. Despite a 2 to 3 times higher risk of adverse pregnancy outcomes, around 2 million HIV positive women give birth each year globally. However, there is a dearth of evidences in Ethiopia about the effect of maternal HIV infection on pregnancy outcomes where adverse birth outcomes are still a significant health problem. This study is, therefore, aimed to examine the effect of HIV on the risk of adverse pregnancy outcomes in Amhara Regional State, Ethiopia.MethodsA prospective cohort study was conducted among 704 pregnant women (352 women with HIV and 352 women without HIV infection). Systematic random sampling technique was employed to select the study participants. Data on socio-demographic, obstetric, clinical, as well as behavioral and psychosocial characteristics were collected using a validated tool. Data on the outcome variables were also collected following delivery. Modified Poisson regression was employed to estimate the relative risk (RR) of HIV on low birth weight (LBW), preterm birth, and still birth at 95% confidence level. Attributable fraction (AF) was used to report the impact of HIV infection on pregnancy outcomes.ResultsOf the total 704 pregnant women enrolled for the study, 96.3% (678) completed the study. The mean age of the study participants was 30.8 (SD ± 5.4) for HIV positive and 27 (SD ± 5.4) for HIV negative women. The cumulative incidence of low birth weight, preterm birth, and stillbirth were 21.4%, 9.4%, and 4.1%, respectively. The incidence of LBW was 24.7% among HIV positive and 17.8% among HIV negative women. The incidence of preterm birth was 10.7% among HIV positive and 7.9% among HIV negative women. And the incidence of stillbirth was 3.7% and 4.6% among HIV positive and those HIV negative women. New-borns from women with HIV infection had a higher risk of low birth weight and preterm birth than those HIV negative women (Adjusted Relative Risk (ARR) = 1.47; 95% CI: 1.06–2.03) and (ARR = 1.74; 95% CI: 1.08–2.79), respectively. The attributable risk of HIV on low birth weight was 32% (Attributable Fraction (AF) = 32%, 95% CI: 23–46%), and 43% (AF = 43%, 95% CI: 23–46%) for preterm birth.ConclusionMaternal HIV infection increased the risk of low birth weight and preterm birth. This implies due attention is required while providing maternal health services primarily antenatal care and delivery services. These services should be aimed at reducing adverse pregnancy outcomes with more attention given to women with HIV infection. Moreover, reinforcement of HIV prevention intervention strategies should be considered at all levels.

Assessment of the impact of HIV infection and anti-retroviral treatment on the cardiometabolic health of pregnant mothers and their offspring (ARTMOMSBABES)

BackgroundThe risk of cardiovascular diseases (CVDs) is becoming more prevalent in pregnant women though not much data is available for pregnant women with human immunodeficiency virus (HIV). Foetoplacental vascular endothelial dysfunction is thought to be at the origin of chronic diseases such as diabetes and obesity later on in life. Because HIV and anti-retroviral treatment (ARTs) are associated with endothelial dysfunction, children exposed in utero to these conditions may be at greater risk of developing CVDs. Despite the high prevalence of HIV in pregnant South African women, little is known about the effects of ART on the cardiovascular health of the mother and offspring. Hence, the proposed study intends to investigate how HIV/ARTs may affect the cardiovascular health of the mother and offspring at different time points during the pregnancy and up to 2 years after birth.MethodsA longitudinal case–control study in HIV positive pregnant women on ART and HIV negative pregnant women will be conducted. All pregnant women will be assessed for cardio-metabolic risk factors and markers (lipids, anthropometric and glycaemic indies, oxidative stress), hemodynamic status (blood pressure parameters) and vascular function (arterial compliance, retinal microvasculature, uterine artery mean pulsatility index). Child health will be monitored in utero and postnatally via routine foetal health screening, placental integrity, anthropometry, blood pressure parameters, markers of oxidative stress and endothelial function in cord blood and cardiovascular epigenetic markers in urine.DiscussionThere is a paucity of studies in South Africa and sub-Sahara Africa as a whole that utilised a longitudinal study model to assess the effects of ARTs on vascular endothelial changes in pregnant women living with HIV and the cardiometabolic health of their offspring. This study will therefore help to monitor changes in cardiometabolic risk during pregnancy and in children exposed in utero to HIV-infection and ART use. Findings from this study will provide useful information for developing guidelines on the use of ARTs in pregnancy and management of cardiometabolic health of the offspring of HIV positive mothers.

Organisms associated with bacterial vaginosis in Nigerian women as determined by PCR-DGGE and 16S rRNA gene sequence.

Bacterial vaginosis (BV) is a condition with diverse etiology. This condition predisposes women to increased susceptibility to sexually transmitted diseases, including human immunodeficiency virus (HIV) infections and preterm birth. The diagnostic methods currently adopted in the evaluation of patient samples for BV are arguably Amsel criteria, and Nugent score that require microscopy and expert interpretation. These two methods are still subjective. The objective of this study was to determine the organisms present in the vagina of 34 HIV negative Nigerian women diagnosed as having bacterial vaginosis by using molecular techniques. The vaginal samples were subjected to DNA extraction, and amplified with eubacterial primers via PCR. The PCR products were separated using denaturing gradient gel electrophoresis (DGGE). Bands were excised, re-amplified, purified and sequenced. Sequence identification was performed using the BLAST algorithm and Genbank data base. Mycoplasma hominis (12/34; 35%) was the most common isolate and 9 (26%) contained one of two clones of an unusual Rainbow Trout intestinal bacterium, while unculturable Streptococcus sp, and other bacteria made up the remaining isolates. The findings indicate further diversity in the etiological agents associated with BV, and raise the question as to whether diagnosis and management of this condition needs to be re-evaluated in countries like Nigeria. There is some controversy over the clinical importance of BV, as it was once regarded as a disease caused by Gardnerella and presenting as an odourous discharge condition, but is now diagnosed without necessarily the presence of these organisms or signs. With the incidence of BV aligned to an increased risk of HIV in a country ravaged by this virus, the effective eradication of BV can only be achieved if appropriate therapies are delivered.

Adiponectin DNA methylation in South African women with gestational diabetes mellitus: Effects of HIV infection.

DNA methylation is increasingly recognized as a potential biomarker of metabolic disease. However, there is limited information on the impact of human immunodeficiency virus (HIV) infection on the candidacy of DNA methylation to serve as molecular biomarkers. This study investigated the effect of HIV infection on DNA methylation patterns in the peripheral blood of South African women with (n = 95) or without (n = 191) gestational diabetes mellitus (GDM). DNA methylation levels at eight CpG sites in the adiponectin gene (ADIPOQ) promoter were measured using bisulfite conversion and pyrosequencing. Differences between HIV negative (-) and positive (+) women were observed. In HIV- women, methylation at CpG -3400 was lower in GDM+ women compared to those with normoglycemia (8.5-fold; p = 0.004), and was associated with higher fasting glucose (β-co-efficient = 0.973; p = 0.006) and lower adiponectin (β-co-efficient = -0.057; p = 0.014) concentrations. These associations were not observed in HIV+ women. In silico analysis showed that Transcription Factor AP2-alpha is able to bind to the altered CpG site, suggesting that CpG -3400 may play a functional role in the regulation of ADIPOQ expression. Our findings show that DNA methylation differs by HIV status, suggesting that HIV infection needs to be taken into consideration in studies exploring DNA methylation as a biomarker of GDM in high HIV prevalence settings.

Detection of human papillomavirus genotypes in human immunodeficiency virus-negative women in Belagavi, Karnataka

BACKGROUND: Women are known to be at high risk of human papillomavirus (HPV) infection and its associated cervical pathology. However, limited data are available on circulating genotypes, especially among human immunodeficiency virus (HIV)-negative women. Therefore, the present study was designed to gauge the prevalence of HPV genotypes in HIV-negative women. MATERIALS AND METHODS: This cross-sectional study was conducted on a total of 96 HIV-negative women in the age range of 18–45 years. Cervical samples were collected from the transformation zone of the cervix using the deoxyribonucleic acid collection device (cytobrush), which was rinsed in 20 ml of PreservCyt® vial (Hologic, Inc.). HPV genotyping was done with the linear array HPV genotyping test (Roche, Branchburg, NJ, USA) at National Aids Research Institute, Pune. RESULTS: A significant linear increasing trend in proportion of carcinogenic and noncarcinogenic genotypes over grade was observed (P = 0.039 and P = 0.0024, respectively). HPV 59 was reported to be the most common genotype followed by 16, 53, 62, and 72 but without any statistical significance. CONCLUSION: Screening strategies incorporating HPV genotyping and vaccination should be effective in preventing cervical cancer in HIV-negative women.

Menopause Symptom Experience and Perceived Well-Being Among HIV Positive and Negative Older Women in Ibadan, Nigeria

Globally, people are living longer with the Human Immunodeficiency Virus (HIV) and older individuals are becoming infected. Menopause symptoms affect women’s health and are associated with perceived declines in wellbeing. This study assessed and compared the menopause symptom experience and perceived wellbeing among HIV positive and negative older women in Ibadan Nigeria Focus group discussions were conducted among menopausal women attending the ARV and GOP clinics at the University College Hospital Ibadan. Opinions of discussants on knowledge and experience of menopausal symptoms, perceptions about the menopause and perceived health status were explored. A total of 90 HIV positive and 92 HIV negative women aged between 40 to 60 years were sampled. Knowledge of the cause of menopause was poor, with more HIV positive women opining that sexual promiscuity causes menopause. The majority of the discussants had adequate knowledge of menopausal symptoms with most of them reporting vasomotor and musculoskeletal symptoms. In both groups, perceptions about the menopause were generally positive as most of them opined that the menopause means freedom from sexual activity and child birth. More HIV negative women perceived themselves to be in good health compared to HIV positive women. Menopause induces many of the same metabolic changes that are being observed with HIV infection, and this may affect the health and quality of life of aging women with HIV infection. There’s a need for health education and health promoting interventions that will help these women in coping with the double burden of HIV infection and menopause.

The Capulana study: a prospective evaluation of cervical cancer screening using human papillomavirus testing in Mozambique

BackgroundCervical cancer is the leading cause of cancer and related deaths among women in Mozambique. There is limited access to screening and few trained personnel to manage women with abnormal...

1330-P: Molecular Biomarkers during Gestational Diabetes Mellitus

Background/Aim: Gestational diabetes mellitus (GDM) is associated with short- and long-term complication in both mothers and offspring. Molecular mechanisms are attracting increased interest for their potential as biomarkers for GDM that could lead to improved detection of GDM with positive effects on health outcomes. The aim of this study was to explore the potential of DNA methylation and single nucleotide polymorphisms (SNPs) to serve as molecular biomarkers for GDM in South African women. Methods: Genome-wide DNA methylation using a MethylationEPIC BeadChip Array (n=24) and gene-specific methylation of the adiponectin (ADIPOQ) gene using bisulfite pyrosequencing (n=286) were profiled in the peripheral blood of women with or without GDM. In addition, variants ADIPOQ rs266729 and rs17300539, and methylenetetrahydrofolate reductase (MTHFR) rs1801133 were quantified using quantitative real-time PCR (n=449). Results: Genome-wide methylation analysis identified 1046 differentially methylated CpG sites (associated with 939 genes), of which 148 CpG sites were hypermethylated and 898 CpG sites were hypomethylated (p<0.01). Among the top five CpG sites, one CpG mapped to the calmodulin-binding transcription activator 1 (CAMTA1) gene, which has been shown to regulate insulin production and secretion. Two CpG sites (-3410: p=0.048 and -3400: p=0.004) in the ADIPOQ promoter were hypomethylated during GDM in Human Immunodeficiency Virus (HIV) negative, but not in HIV positive women. Lastly, no association between ADIPOQ and MTHFR polymorphisms and GDM was observed in our population. Discussion: DNA methylation may offer potential as molecular biomarkers for GDM in a South African population. Future longitudinal studies in larger samples that include both HIV negative and positive pregnant women are warranted to explore the candidacy of DNA methylation as molecular biomarkers for GDM. Disclosure S. Dias: None. S. Adam: None. P. Rheeder: None. J. Louw: None. C. Pheiffer: None. Funding National Research Foundation (99391); South African Medical Research Council

Primary effusion lymphoma in a human immunodeficiency virus-negative patient with unexpected unusual complications: a case report

BackgroundPrimary effusion lymphoma is a rare, high-grade non-Hodgkin’s lymphoma that usually occurs in immunosuppressed or human immunodeficiency virus-positive individuals in advanced stages of the disease. However, primary effusion lymphoma occasionally affects immunocompetent patients who are infected with human herpes virus type 8 or Epstein-Barr virus. This disease manifests with liquid collections in cavities, producing constitutional symptoms; fever; weight loss; and symptoms related to extrinsic compression, such as dyspnea or abdominal discomfort. Diagnosis is confirmed with cytological or tissue evaluation showing large, multinucleated lymphoid cells with positive specific markers for the disease, such as CD45 and markers related to viral infections, when present. There is no standard treatment for primary effusion lymphoma, but several chemotherapy protocols are recommended, usually with poor results.Case presentationWe present a case of an adult human immunodeficiency virus-negative Hispanic origin woman with primary effusion lymphoma with pleuritic, pericardial, and peritoneal compromise who also had unusual complications during a diagnostic procedure: the accidental rupture of the left ventricle and the development of a secondary left ventricular pseudoaneurysm. We describe the clinical, radiological, and laboratory characteristics as well as the outcome of this case.ConclusionsPrimary effusion lymphoma is a very rare entity that represents 4% of non-Hodgkin’s lymphoma cases associated with human immunodeficiency virus and 0.1% to 1% of all lymphomas in patients with another type of immunodeficiency in regions where human herpes virus type 8 is not endemic. This reported case is an unusual presentation of primary effusion lymphoma because it occurred in an immunocompetent human immunodeficiency virus-negative adult woman without the presence of Kaposi’s sarcoma or Castleman’s disease and for whom the clinical course after chemotherapy was successful. However, the rupture of the free wall of the left ventricle is a very rare catastrophic event that usually occurs after myocardial infarction. Left ventricle free wall rupture rarely goes unnoticed, but when it occurs, it leads to the development of a ventricular pseudoaneurysm in which the rupture is contained by the pericardium with an organized thrombus and an adjacent hematoma.

Effect of highly active antiretroviral therapy on growth and development of infants and children

Objective To investigate the effect of high active antiretroviral therapy (HAART) on growth and development of infants born to pregnant women infected with human immunodeficiency virus (HIV) and the effect on blocking mother to children transmission. Methods Totally 165 pregnant women diagnosed with HIV infection from May 2006 to May 2017 and their 169 infants, including four pairs of twins were enrolled, and 82 infants born to HIV negative pregnant women in the same period were enrolled as control. All of the pregnant women in the experimental group were administrated with HAART when HIV antibody test was positive. The delivery intervention and artificial feeding were carried out as well. The weight, height, hemoglobin (Hb), serum iron and serum calcium level of infants at birth, 12 months and six years old were monitored and compared between the two groups. Apgar scores of newborns and intelligence tests at six-year-old were also recorded. Statistical analysis was performed by t test. Results Pregnant women were generally in good conditions and well tolerated to the drugs. There were no significant differences in neonatal Apgar scores, body weight, body length, Hb, serum iron, serum calcium and CD4+ T lymphocyte count between HIV positive experimental group and control group (t =-1.27, -1.12, -3.41, -5.62, -0.89, -3.02 and-0.74, respectively, all P>0.05). At the age of 12 months, there were no significant differences in body weight, length, Hb, serum iron, serum calcium and CD4+ T lymphocyte count between the two groups (t = 1.02, 1.41, 1.32, 1.03, 0.89 and 1.06, respectively, all P > 0.05). At the age of six years, there were no significant differences in all indexes between the two groups (t= 1.02, 0.87, 1.58, 1.03, 0.92 and 2.07, respectively, all P > 0.05). Intelligence assessment was performed in 78 children of the experimental group and 45 children of the control group at the age of six years, and there was no significant difference between the two groups ((89.7±12.5) score vs (91.2±13.7) score, t=1.67, P=0.43). All the children in the experimental group were positive for HIV antibody at birth, and six cases were positive for HIV RNA who were diagnosed with neonatal HIV infection. HAART was initiated for the six cases, while HIV antibody tests were still positive until the age of 18 months after HAART. The rest of the children′s HIV antibody tests became negative with the mother to children tramsission rate of 3.55% (6/169). Conclusion HAART could not only block mother to children tramsission of HIV, but also has no effect on growth and intellectual development of children during the observation period. Key words: Antiretroviral therapy, highly active; Human immunodeficiency virus; Child; Growth and development

The Correlation between HIV/AIDS Positive Pregnant Mother with Infant APGAR Score in RSD dr. Soebandi Jember

Human Immunodeficiency Virus (HIV) is a virus that decreased immunity and a set symptoms of diseases called Acquired Immune Deficiency Syndrome (AIDS). One of the major risk factors for HIV transmission is perinatal transmission about 2.8% during pregnancy, delivery, and postpartum. HIV positive mothers have a potential to give birth infants with low APGAR. APGAR Score was used as a reference to determine asphyxia in the first and fifth minutes of life. The purpose of this research were to determine the correlation between HIV/AIDS positive pregnant mother with infant APGAR Score and to determine the other factors that affect the infant APGAR Score in RSD dr. Soebandi Jember. This research used observational analytic survey method with cross sectional design using medical record of HIV positive and negative pregnant women from August 2014-July 2017 in RSD dr. Soebandi Jember as a subject that qualify the inclusion and exclusion criteria. This research used case group sampling technique by total sampling and control group by simple random sampling each 52 samples. Test result of the correlation between HIV/AIDS positive pregnant mother with infant APGAR Score using Chi-Square test obtained p value=1.000 (OR=1.13) that means there was no significant correlation. Test result of the correlation between the other factors that affect infant APGAR Score concluded that there were no significant correlation.
 Keywords: pregnant mother, HIV/AIDS, APGAR Score, infant

Association of Progestin Contraceptive Implant and Weight Gain

To evaluate initiation of a two-rod, 150-mg levonorgestrel contraceptive implant on women's perceived and observed body weight. We conducted a secondary analysis of data from an open, randomized controlled trial of adult, nonpregnant, human immunodeficiency virus-negative women attending a public clinic in Kingston, Jamaica, who were assigned to initiate implant use either immediately or after a 3-month delay. The primary objective of the parent study was to assess the effect of initiation of the implant on the frequency of condom use. We compared study arms during follow-up using one-sided χ tests for differences in perceived weight gain and loss, one-sided Wilcoxon-Mann-Whitney tests for median gain in measured weight, and logistic regression with generalized estimating equations for risk of gaining greater than 2 kg. From 2012 to 2014, women were assigned to the implant (n=208) or delay arm (n=206). At 3 months, more women in the implant arm (15.3%) reported perceived weight gain than in the control arm (4.3%) (P=.01). Despite differences in perception, the implant and control arms did not differ significantly in median weight gain at 1-month (0.0 kg and 0.0 kg, respectively; P=.44) and 3-month visits (0.5 kg and 0.0 kg, respectively; P=.27). Study arms did not differ in risk of gaining greater than 2 kg (odds ratio 0.9, 95% confidence interval 0.6-1.3). We found no evidence of weight gain from short-term implant use. Through the power of the nocebo effect, the practice of counseling women to expect possible weight gain from initiating implant use could lead them to perceive weight gain even in its absence and contribute to the early discontinuation of this highly effective contraceptive method.

Cervical PAP Smear Examination in Women Living with HIV-A study of 60 cases

Cervical cancer in women living with Human Immunodeficiency Virus (HIV) is a major health problem accounting for 26.1-43.8% of all cancers in Indian Women. Women infected with HIV have a higher risk of developing cervical intraepithelial neoplasms. Dysplasia has been reported in 15 to 64.6% of HIV infected women & these rates are 10-12 times higher than those observed among HIV negative women 13%. Materials and Methods: The aim of this study is to estimate the frequency of abnormal Papanicolau (Pap) smears and mainly to detect precancerous & cancerous lesions as well as inflammatory lesions in HIV-infected women. Results: Total 68 samples were collected. Pap smear abnormalities included LSIL(10.2%). HSIL(4.4%), ASCUS(8.8%), ASC-H(2.9%), Carcinoma(1.4%), Specific Infections 33.8% (Bacterial Vaginosis-19.1%, Trichomonas Vaginalis-5.8%, Candidiasis-5.8%, Herpes Simplex-2.9% Cytolytic smear-1.4%), Non-specific Inflammatory smear (36.7%). Conclusion: In view of high percentage of inflammatory Pap smears, infections and cervical intraepithelial lesions among HIV positives women. Among the various intraepithelial lesions LSIL was the commonest, stressing the need for routine pap smear testing annually in women living with HIV. Keywords: HIV, Pap smear, patient living with HIV, Cervical intraepithelial neoplasia

Prevalence of preeclampsia among human immunodeficiency virus-positive pregnant women as compared to human immunodeficiency virus-negative women in Ibadan

Introduction: Preeclampsia is a common complication of pregnancy and a major cause of maternal morbidity. Pathogenetic explanations for preeclampsia include: Maladaptation of the immune system to paternal antigens and exaggerated maternal inflammatory response to trophoblastic tissue. Immune deficiency, induced by human immunodeficiency virus (HIV) or any other cause, could, therefore, inhibit a tendency to immune hyper-reactivity and thus theoretically prevent the development of preeclampsia. The study aims to explore the role of the immune theory of preeclampsia by comparing the prevalence of preeclampsia among HIV-positive and HIV-negative pregnant women. Materials and Methods: The study was a cross-sectional survey of pregnant women, beyond 28 weeks gestation, who delivered at the University College Hospital, Ibadan between 1st October 2011 and 31st December 2011. Data was collected using a prespecified proforma. The analysis was performed using SPSS version 17.0 and P value was set at <0.05. Results: A total of 766 women who gave birth during the study met the inclusion criteria. Among the cohort, HIV prevalence rate was 7.2% whereas preeclampsia was 10.7%. None of the HIV-positive women had preeclampsia. Conclusion: This study suggested that the prevalence and perhaps, risk of developing preeclampsia is reduced among HIV positive women. This is similar to other studies done in various countries in the world. There is a need for further study as it may prove valuable in the management and prevention of preeclampsia.

Anal Cytology and Human Papillomavirus Genotyping in Women With a History of Lower Genital Tract Neoplasia Compared With Low-Risk Women.

To compare the prevalence of abnormal anal cytology and high-risk human papillomavirus (HPV) among women with a history of HPV-related genital neoplasia with women without a history of HPV-related genital neoplasia. A cross-sectional cohort study was performed from December 2012 to February 2014. Women were recruited from outpatient clinics at an academic medical center. Women with a history of high-grade cervical, vulvar, or vaginal cytology, dysplasia, or cancer were considered the high-risk group. Women with no history of high-grade anogenital dysplasia or cancer were considered the low-risk group. Human immunodeficiency virus-positive women were excluded. Anal cytology and HPV genotyping were performed. Women with abnormal anal cytology were referred for high-resolution anoscopy. There were 190 women in the high-risk group and 83 in the low-risk group. The high-risk group was slightly older: 57 years compared with 47 years (P=.045); 21.7% of low-risk women had abnormal anal cytology compared with 41.2% of high-risk women (P=.006). High-risk HPV was detected in the anal canal of 1.2% of the low-risk group compared with 20.8% of the high-risk group (P<.001). Among women who underwent anoscopy, no anal dysplasia was detected in the low-risk group, whereas 13.4% in the high-risk group had anal dysplasia with 4.2% having anal intraepithelial neoplasia 2 or greater (P<.001). Human immunodeficiency virus-negative women with a history of lower genital tract neoplasia are more likely to have positive anal cytology, anal high-risk HPV, and anal intraepithelial neoplasia. Anal cancer screening should be considered for these high-risk women. II.

English

The interaction between human papilloma virus (HPV) and human immunodeficiency virus (HIV), both sexually transmitted infections appears to be related to the alteration in cell-mediated immunity in HIV infected persons. Linkage studies of HIV/AIDs and cancer registries have indicated a 2 to 22 fold increase in cervical cancer in HIV positive women compared to HIV negative women. Data on the prevalence of HPV types in invasive cervical carcinoma (ICC) suggest that the proportion of infection with types HPV16/18 (responsible for over 70% of all cervical cancers) is similar in HIV negative and HIV positive women. The biological interaction between HIV and HPV needs further elucidation, although there is some evidence that the presence of HPV infection may be associated with increased HIV transmission. Adolescents perinatally infected by HIV are known to have higher rates of HPV infection and also have been shown to seroconvert in response to HPV vaccination with the quadrivalent vaccine, albeit to lower titers than HIV negative individuals. Anal cancer incidence is greatly increased in HIV positive individuals, particularly in HIV positive men who have sex with men. Screening for anal cancer precursors is feasible and effective; however, the impact on reduction of anal cancer remains to be demonstrated. There are ongoing studies on the safety, immunogenicity, and efficacy of current HPV vaccines in HIV positive individuals and mature data are awaited. &nbsp; Key words: human immunodeficiency virus (HIV), human papilloma virus (HPV), cervicovaginal cancer.

Evaluation of See-and-Treat Cervical Cancer Screening in Human Immunodeficiency Virus–Positive and Human Immunodeficiency Virus–Negative Women in Cameroon [332

Evaluation of See-and-Treat Cervical Cancer Screening in Human Immunodeficiency Virus–Positive and Human Immunodeficiency Virus–Negative Women in Cameroon [332

Comparative study of preinvasive and invasive lesions of the cervix in HIV-positive and HIV-negative women

Background: Evidence suggests that Human Immunodeficiency Virus (HIV) infection is a risk factor for preinvasive and invasive lesions of cervix but confusion regarding pathogenesis and progression of cervical neoplasia in HIV-positive women still prevails. Aims : To find the incidence of cervical neoplasia in HIV positive and HIV-negative women and to study the impact of CD4 counts, duration of HIV infection, and treatment with highly active antiretroviral therapy (HAART) on the incidence of cervical lesions in HIV positive women. Materials and Methods : It was an observational case control study carried over a period of one year at the Department of Obstetrics and Gynaecology and Department of Medicine, King George Medical University, Lucknow. Cases were HIV-positive women and controls were HIV negative women. Those with previous diagnosis or treatment for cervical neoplasia, history of total hysterectomy or coexistent immunosuppressive conditions were excluded. All subjects had cervical screening by Pap smear. Colposcopy and cervical biopsy were done if indicated. Statistical Analysis Used : Chi square test, univariate, and multivariate analysis. Results: The incidence of cervical lesions in HIV-positive women (159.66 per 1000 screened women) was higher compared to HIV-negative women (15.15 per 1000 screened women) ( P 3 were associated with an increased incidence of cervical neoplasia ( P P Conclusions: Seropositivity is associated with an increased incidence of cervical lesions. This risk is further enhanced by CD4 counts less than 500/mm 3 and duration of HIV infection of more than two years.

Role of GeneXpert MTB/Rif Assay in Diagnosing Tuberculosis in Pregnancy and Puerperium

Presentation of tuberculosis (TB) in pregnancy may be atypical with diagnostic challenges. Two patients with complicated pregnancy outcomes, foetal loss and live premature delivery at 5 and 7 months of gestation, respectively, and maternal loss, were diagnosed with pulmonary TB. Chest radiography and computed tomography showed widespread reticuloalveolar infiltrates and consolidation with cavitations, respectively. Both patients were Human Immunodeficiency Virus (HIV) seronegative and sputum smear negative for TB. Sputum GeneXpert MTB/Rif (Xpert MTB/RIF) was positive for Mycobacterium tuberculosis. To strengthen maternal and childhood TB control, screening with same-day point-of-care Xpert MTB/RIF is advocated among both HIV positive pregnant women and symptomatic HIV negative pregnant women during antenatal care in pregnancy and at puerperium.