Squamous Intraepithelial Lesions In Women Research Articles

Risk factors for vaginal squamous intra-epithelial lesions in women with high-grade cervical lesions

ObjectiveTo investigate the high-risk factors associated with concurrent cervical intra-epithelial neoplasia (CIN) and vaginal intra-epithelial neoplasia (VaIN) in patients with high-grade lesions.MethodsThis retrospective study at the Obstetrics and Gynecology Hospital...

Safety of Conservative Management of High-Grade Squamous Intraepithelial Lesion in Women Under 30 Years Old.

Objectives:To evaluate the outcomes of conservative management in young women with high-grade squamous intraepithelial lesion (HSIL).Methods:A retrospective cohort study included women younger than 30 years referred with HSIL (cytology or biopsy) managed conservatively from 2012 to 2019, in Campinas/Brazil. Regression was the outcome when no evidence of HSIL was observed in at least two consecutive follow-ups. Kaplan–Meyer method was used to determine regression probabilities. Other tests were chi-square or Fisher, Mann–Whitney and COX regression.Results:During the study period, 89 patients were included. No progression to microinvasive or invasive cancer was observed. Sixty-one (69%) patients were younger than 25 years, and 28 (31%) were aged 25–30 years. Spontaneous regression was seen in 64 (72%) and persistence in 25 (28%) of the overall sample. The average time to regression was 15.4 months (standard deviation [SD] = 7.7), and the follow-up time was 31.6 months (SD 19.0). Age, parity, first sexual intercourse, smoking, hormonal contraception, and colposcopy impression were not different among women with regression or persistence. Regression probabilities were, respectively, 28.9%, 60.2%, and 78.1% after 12, 18, and 24 months. Most of the events happened between 12 and 18 months of follow-up.Conclusions:Conservative management in women younger than 30 years was safe: spontaneous regression was observed in 72% of all women younger than 30 with HSIL managed conservatively. No clinical variable was relevant, influencing regression. In 2 years the regression probability was 78%.

Xpert HPV as a Screening Tool for Anal Histologic High-Grade Squamous Intraepithelial Lesions in Women Living With HIV.

Women living with HIV (WLWH) experience high rates of anal cancer. Screening using anal cytology, high-resolution anoscopy (HRA) with biopsies, can histologically diagnose anal cancer precursors called high-grade squamous intraepithelial lesions (HSIL). The low specificity of screening using anal cytology results in HRA referral for many WLWH without HSIL. Screening using high-risk human papillomavirus (HR-HPV) may improve specificity. Two hundred seven WLWH (63% non-Hispanic black) were screened for anal histologic HSIL (hHSIL) using cytology, HRA-guided biopsies, and Xpert HPV. Xpert performance for predicting anal hHSIL was compared with that of cytology. Usng Xpert 5 HPV genotypic results and accompanying cycle thresholds, receiver operator characteristic curve and recursive partitioning analyses were used to create predictive models for hHSIL. The performance of Xpert to predict hHSIL was not different from that of cytology with a sensitivity (Sn) of 89% and specificity (Sp) of 49%. Interpretation of Xpert was modified using genotypic results and receiver operator characteristic curve analysis, which produced a screen with an Sn and Sp of 75% and 84% for hHSIL, respectively. Another reinterpretation of Xpert was created using recursive partitioning and cycle thresholds, which predicted hHSIL with an Sn and Sp of 75% and 86%, respectively. The detection of HPV-16 was highly predictive of hHSIL in all analyses. These modified screening tests would reduce HRA referral in this population by almost half compared with anal cytology. Xpert HPV is an alternative to anal cytology to screen for anal HSIL and can be optimized to reduce the number of unnecessary HRAs performed in WLWH.

Risk factors modulating the course of low-grade squamous intraepithelial lesions in women of reproductive age

Background. Infection with oncogenic types of human papillomavirus (HPV) is the leading cause of cervical cancer and its immediate precursors – squamous intraepithelial lesions. However, the persistence of HPV may not be sufficient for the occurrence of malignant transformation, and there may be other exogenous or endogenous factors that, in combination with the virus, increase the risk of developing and progressing cervical neoplasia.Objective: identification of risk factors that modulate the course of low-grade squamous intraepithelial lesions (LSIL) in women of reproductive age.Materials and methods. In 110 women aged 18 to 45 years with a diagnosis of LSIL, we evaluated the impact of risk factors (sexual behavior, reproductive function, contraceptive methods, smoking, HPV infection) on the course of the process (recovery, persistence or progression) during the 12-month follow-up period. HPV testing was performed by real-time PCR.Results. The average age of the study participants was 31.55 ± 7.17 years. Our observations showed that frequent artificial abortions, the practice of risky sexual behavior (early sexual debut, frequent change of sexual partners) increased the risk of persistence and progression of mild cervical cytological abnormalities. The use of oral contraceptives, barrier contraception and smoking did not affect the outcome of the disease.The prevalence of HPV among women with LSIL was 70.91 % (78/110). The predominant types were HPV 16 (35.45 %), HPV 33 (12.73 %) and HPV 18 (12.73 %). HPV 16 was more common in the progression group (62.50 %) than in the regression and persistence groups (14.63 % and 43.40 %, p <0.05). Progression of neoplasias was more often observed in patients with signs of multiinfection of the cervical epithelium with HPV. Single HPV infection was higher in the group of recovered women.Conclusions. The study found that a large number of induced abortions, the practice of risky sexual behavior, the presence of HPV type 16 and multiple HPV infection are factors contributing to the persistence of LSIL and progression to HSIL. These data may be useful for the management of women with mild cervical cytological abnormalities.

Human Papillomavirus Vaccination Prior to Loop Electroexcision Procedure Does Not Prevent Recurrent Cervical High-grade Squamous Intraepithelial Lesions in Women Living With Human Immunodeficiency Virus: A Randomized, Double-blind, Placebo-controlled Trial.

Women living with human immunodeficiency virus (HIV), especially in sub-Saharan Africa, are at high risk for cervical high-grade squamous intraepithelial lesions (HSIL) and cervical cancer. These women have high HSIL recurrence rates after loop electroexcision procedure (LEEP). Retrospective studies suggest that human papillomavirus (HPV) vaccination improves response to treatment of cervical HSIL. We performed a double-blind, randomized clinical trial enrolling 180 women living with HIV in Johannesburg, South Africa, diagnosed with cervical HSIL by colposcopic biopsy. Women received quadrivalent HPV vaccine or placebo (1:1) at entry, week 4, and week 26. LEEP was performed at week 4. Colposcopic-directed biopsies and cervical cytology were performed at weeks 26 and 52. The primary endpoint, cervical HSIL by histology or cytology at either week 26 or 52, was compared between arms using χ 2 analysis. Participant characteristics included median age of 39 years and median CD4 count 489 cells/μL, and 94% had HIV suppression. One hundred seventy-four women completed the vaccine/placebo series and had evaluable results at week 26 or 52. The proportion experiencing the primary endpoint was similar in the vaccine and placebo groups (53% vs 45%; relative risk, 1.18 [95% confidence interval, .87-1.6]; P = .29). HSIL recurrence was associated with a LEEP biopsy result of HSIL and detection of HSIL at the margins of the LEEP sample. This study did not support HPV vaccination to prevent recurrent HSIL after LEEP in women living with HIV. Recurrent HSIL was high despite virologic suppression. Improved treatments are needed for HSIL to reduce the burden of cervical cancer among women living with HIV. NCT01928225.

Screening strategies for the detection of anal high-grade squamous intraepithelial lesions in women living with HIV.

HIV-infected women (WLHIV) have more than 10-fold higher risk for squamous cell cancer of the anus. Experts suggest cytology-based strategies developed for cervical cancer screening may prevent anal cancer by detecting anal cytologic or histological high-grade squamous intraepithelial lesion (hHSIL) for treatment. Currently, there is no consensus on anal-hHSIL screening strategies for WLHIV. Between 2014 and 2016, 276 WLHIV were recruited at 12 US AIDS Malignancy Consortium clinical trials sites to evaluate hHSIL prevalence and (test) screening strategies. Participants completed detailed questionnaire, underwent anal assessments including high-risk human papillomavirus (hrHPV) testing using hrHPV-Hybrid Capture 2 (HC2) and hrHPV-APTIMA, anal cytology, and concurrent high-resolution anoscopy. Screening test characteristics for predicting hHSIL validated by central review of histologic diagnosis were estimated sensitivity, specificity, positive predictive value, and false-omission rate. Paired analyses compared sensitivity and specificity for hrHPV single tests to anal cytology alone. 83% (229/276) of enrolled WLHIV had complete anal assessment data and were included in this analysis. Mean age was 50, 62% black and 60 (26%) had hHSIL. Anal cyotology (>atypical squamous cells of undetermined significance), hrHPV-HC2, and hrHPV-APTIMA sensitivity estimates were similarly high (83, 77, and 75%, respectively, P values > 0.2). Specificity was higher for both hrHPV-APTIMA and hrHPV-HC2 compared with anal cytology (67 vs. 50%, P < 0.001) and (61 vs. 50%, P = 0.020), respectively. Anal hrHPV testing demonstrated similar sensitivity for anal cytology (>atypical squamous cells of undetermined significance) to predict anal hHSIL. Among tests with similar sensitivity, the specificity was significantly higher for hrHPV-APTIMA and hrHPV-HC2. Thus, anal hrHPV testing may be an important alternative strategy to anal cytology for anal hHSIL screening among WLHIV.

Screening for intra-anal squamous intra-epithelial lesions in women with a history of human papillomavirus-related vulvar or perianal disease: results of a screening protocol.

Women with a history of human papillomavirus (HPV)-related cervical, vaginal or vulvar high-grade squamous intra-epithelial lesions (HSILs) or cancer are at increased risk of developing anal squamous intra-epithelial lesions (SILs) or a squamous cell carcinoma of the anus (SCCA). Screening for intra-anal SILs with high-resolution anoscopy (HRA) in high-risk populations is a subject of debate. In this study we aimed to answer the following question: what is the prevalence of intra-anal (H)SIL in women with HPV-related vulvar and/or perianal disease using HRA for screening? A retrospective study was performed to evaluate the prevalence of intra-anal (H)SIL in women with a history of vulvar and/or perianal HSIL or (superficially invasive) squamous cell carcinoma (SCC). This study was performed between 2015 and 2018 following implementation of a protocol for intra-anal screening using HRA. Twenty-seven patients, 10 with a history of (superficially invasive) SCC (four vulvar, five perianal, one multizonal) and 17 with HSIL as the worst diagnosis (two perianal, 15 multizonal) were screened for intra-anal lesions using HRA. No anal cancer was found at screening, 6 (22%) patients were diagnosed with intra-anal HSIL and 12 (44%) patients with intra-anal low-grade SIL. We found a high prevalence of intra-anal HSIL in women previously diagnosed with vulvar and perianal HSIL. Given the clear link between HSIL and SCCA, screening for intra-anal lesions in women with HPV-related genital pathology seems warranted. Future studies should focus on the effect of HSIL treatment on the prevention of anal cancer.

Use of electrical impedance spectroscopy as an adjunct to colposcopy in a pathway of cervical intraepithelial neoplasia diagnostics.

Screening with cytology decreases cervical cancer burden, but new methods have emerged. We assessed thediagnostic value of electrical impedance spectroscopy (EIS) in the real-world gynecological setting. The study aimed todetermine the diagnostic usefulness of EIS used as an adjunct to colposcopies in the diagnosis of high-grade squamousintraepithelial lesions in women with abnormal cytology findings. A cross-sectional, single center, observational study considered 143 women. All were subjected toa colposcopy and EIS with ZedScan. ZedScan-guided or colposcopically-guided biopsies were carried out. Data from 118 women were analyzed. The average age of the included women was 38.29 } 12.52 years (range:22-86 years). Overall, 27 had a diagnosis of CIN2+ and above on histopathological examination, 99 had low-grade colposcopyresults, 18 had high-grade colposcopy results, and 80 had positive ZedScan examination. No adverse events relatedto the examination with ZedScan were observed. EIS used as an adjunct to colposcopies showed sensitivity of 96.30%(95% CI: 81.03-99.91) and specificity of 39.56% (95% CI: 29.46-50.36), and accuracy of 52.54% (95% CI: 43.15-61.81). Theprocedure allowed to detect 11 additional cases with positive histo-pathological result in comparison to colposcopies alone. Colposcopies performed with ZedScan as an adjunct were effective in detecting high-grade cervical lesions.Advantages of ZedScan include real-time result display, no additional diagnostic burden posed on the patient, andgood safety profile. Studies on large patient cohorts are needed for further evaluations of this diagnostic procedure andfactors which may affect its diagnostic accuracy.

Prevalence of and Risk Factors for Anal High-grade Squamous Intraepithelial Lesions in Women Living with Human Immunodeficiency Virus.

Women living with human immunodeficiency virus (WLHIV) have disproportionately high rates of squamous cell carcinoma of the anus compared with the general population of women. Anal high-grade squamous intraepithelial lesions (HSILs) precede anal cancer, and accurate studies of HSIL prevalence among WLHIV in the United States are lacking. The AIDS Malignancy Consortium 084 study was a multicenter national trial to evaluate the prevalence of and risk factors for anal HSIL in a US cohort. Eligible participants were WLHIV aged ≥18 years with no history of anal HSIL. Study participants had an examination including collection of cervical/vaginal and anal specimens, followed by high-resolution anoscopy with biopsy. We enrolled 256 women with evaluable anal pathology. The mean age was 49.4 years, 64% women were non-Hispanic black, 67% were former or current smokers, and 56% reported ever having anal sex with a man. The median CD4 T-cell count was 664 cells/μL. The prevalence of anal histologic HSIL (hHSIL) was 27% (95% confidence interval [CI], 22%-33%). There was a strong concordance (240/254) between local and consensus pathologists for hHSIL vs less than hHSIL (κ = 0.86 [95% CI, .79-.93]). Current CD4 count of ≤200 cells/μL was the strongest predictor of consensus anal hHSIL diagnosis (adjusted odds ratio [aOR], 10.34 [95% CI, 3.47-30.87]). History of anoreceptive intercourse was also associated with hHSIL (aOR, 2.44 [95% CI, 1.22-4.76]). The prevalence of anal hHSIL in WLHIV in the United States was 27% in this study where all participants received high-resolution anoscopy and biopsy.

Diagnostic Test Accuracy of Mobile Colposcope, HR-HPV Testing, VIA for Detection of Cervical High-grade Squamous Intraepithelial Lesions in Women Living With HIV

Diagnostic Test Accuracy of Mobile Colposcope, HR-HPV Testing, VIA for Detection of Cervical High-grade Squamous Intraepithelial Lesions in Women Living With HIV

17 - Screening for anal dysplasia in women with a history of human papillomavirus related lower genital tract pathology

Background Women with a human papillomavirus related history of cervical, vaginal or vulvar high-grade dysplasia or cancer are at increased risk to develop anal dysplasia or anal cancer. Screening for anal cancer precursors (squamous intraepithelial lesions (SIL)) with high resolution anoscopy (HRA) in high-risk populations is subject of debate. In this study we evaluated standardized intra-anal SIL screening using HRA in high-risk female patients. Methods A retrospective observational study was performed to evaluate the prevalence of intra-anal SIL in women with a history of vulvar high-grade SIL (HSIL) and perianal HSIL diagnosed at the Netherlands Cancer Institute, who were referred for intra-anal SIL screening using HRA in the MC Slotervaart between 2015 and 2017. Results 22 female patients were screened for anal SIL using HRA. 19 females had a history of biopsy proven vulvar HSIL and 19 females had a history of biopsy proven perianal HSIL. Eleven (50%) patients had a history of multizonal HSIL at three or more perianogenital locations. No anal cancer was found at screening, 7 (32%) patients were diagnosed with anal HSIL and 7 (32%) patients with low-grade anal SIL. Conclusions We found a high prevalence of anal HSIL in women with HPV related lower genital tract dysplasia. Intra-anal SIL screening using HRA in this high risk population seems to be justified. However, HRA is an invasive screening method. Studying other, less invasive screening methods remains important.

Loop electrosurgical excision procedure versus expectant management to treat high-grade squamous intraepithelial lesion in women up to 25 years

considerably.Aim: To determine outcome of regression in a cohort of women younger than 25 years old with cervical intraepithelial neoplasia grade 2 and 3 (CIN2/3) undergoing treatment with Loop Electrosurgical Excision Procedure (LEEP) or observational management.Methods: Prospective cohort study was carried out between April 2015 and January 2017 with all newly diagnosed biopsy-proven CIN2/3 outpatients. Analysis was performed that compared women who had immediate surgical treatment with women who chose expectant management. The primary outcome was development of high-grade changes (defined as cytological evidence of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H), HSIL, adenocarcinoma in situ, atypical glandular cells (AGC), or worse) from at least one Pap Smear (PS) collected every 6 months in the minimum follow-up of 1 year. Comparisons were made using Cox proportional hazards regression analysis.Results: Sixty-four women were diagnosed through cervical biopsy with CIN 2/3 and could choose between conservative or surgical treatment. In the group up to 19 years of age, 6 (37.5%) with CIN2 chose the expectant management and 10 (62.5%) LEEP. While among 20-25-year-old women, 38 (79.2%) chose surgery and 10 (20.8%), being just 4 with CIN3, chose only follow-up for 1 year. The risk of cytological high-grade abnormality over the follow-up period was 62.5% for expectant management and 4.2% for LEEP group (p=0.001).Conclusion: Women aged up to 25 years with CIN2/3 undergoing treatment with LEEP had a significantly lower risk of cytological high-grade abnormality at 12 months follow-up compared with those who remained only under clinical observation.

Evaluation of Direct Visual Inspection of the Cervix in Detecting Cytology Diagnosed Squamous Intraepithelial Lesion in Women of known HIV Status. A Randomized Trial (CANHIV Study).

A two-arm, open label, randomized study, evaluated the test characteristics of visual inspection of cervix with Acetic acid(VIA) and Lugol‟s Iodine(VILI) in detecting cytology diagnosed squamous intraepithelial lesion(SIL) in 1160 women of known HIV status in southwestern Nigerian. Using SIL as reference standard and the HIV status masked, VIA and VILI had similar test characteristics except for the positive predictive value in which VIA value of 91.5% was significantly higher than 77.7% for VILI ( p=0.01). Among HIV positive women, VILI performed poorly across all the 4 test characteristics compared to VIA. Among severely immuno-compromised HIV positive participants VILI performance was consistently below 80% across all test characteristics (sensitivity-70.0%; specificity-66.9%; positive predictive value-46.7%; negative predictive value(NPV)-50.0%) compared to VIA (Senstivity-71.3%; specificity-88.2%; positive predictive value-83.3%; negative predictive value -88.2). Our study shows that VILI is insufficiently sensitive and specific in the presence of HIV infection especially in those with severe immunosuppression. Based on VIA‟s acceptable sensitivity and NPV in all situations, it is recommended for cervical cancer screening in HIV positive women and in settings of high HIV burden.

Integrating Cervical Cancer Screening with HIV Care in Cameroon: Comparative Risk Analysis of Cervical Disease in HIV-Infected Women Receiving Antiretroviral Therapy to Women in the General Population

BackgroundWhile the effect of highly active antiretroviral therapy (HAART) on natural history of cervical lesions remains controversial, resource limited countries need to understand the relevance of their own data to their settings. We compared the risk of cervical disease in HAART-experienced women with that in women in the general population of Cameroon.MethodsA retrospective cross sectional survey of women aged 35 years and above, attending a voluntary screening campaign for cervical cancer at the Nkongsamba Regional Hospital in Cameroon between February and May 2014. Squamous intraepithelial lesions (SIL) were determined by Pap smear. Multiple logistic regression was used to compare the odds of SIL in women on HAART to women from the community with unknown HIV status.ResultsIncluded were 302 women of whom 131(43.4%) were HIV-infected and receiving HAART on the site while 171 (56.6%) were women from the community. Cervical disease was observed in 51(16.9%) persons of whom 15 (11.5%) cases in the HAART group and 36 (21.1%) cases in the general group (p = 0.027). After controlling for age and other covariates, women in the HAART group had a 67% reduction in the odds of cervical lesions compared with the community group [adjusted odd ratio (aOR) = 0.33, 95%CI: 0.15–0.73, p = 0.006).ConclusionHIV-infected women receiving HAART have a lower risk of cancer than women in the general population. This finding may not be attributed to HAART alone but to all the health benefits derived from receiving a comprehensive HIV care.

The Risk of High-Grade Squamous Intraepithelial Lesions in Women with Low Serum Levels of Vitamin A

Background: The progression of the cervical squamous intraepithelial lesion (SIL) is associated with many cofactors, and nutritional aspects are gradually assuming an important role in understanding the physiopathogenesis. Objective: To assess the serum levels of retinol in women from a poor region of Brazil with a histological diagnosis of cervical high-grade SIL (HSIL). Methods: A cross-sectional study was conducted in 62 women aged 14-48 years who had a cervical biopsy and were treated at the Federal University of Ceara in Fortaleza, Brazil. Serum retinol levels were measured in peripheral blood by a spectrophotometry technique. Values were categorized as subnormal (<20 µg/dl) or normal (≥20 µg/dl). Multivariate logistic regression was used to determine the association between serum levels of retinol and HSIL for a confidence interval of 95%. Results: Twenty-six out of 62 women (42%) had a negative histopathological result for SIL and 36 (58%) were diagnosed with SIL (20 low SIL and 16 high SIL). The level of retinol was more frequently low in women with HSIL, but there was no statistical significance [p = 0.409, OR: 2.26 (0.33-15.59)]. Conclusion: There was no association between high SIL and low levels of retinol in peripheral blood.

Is screening for anal squamous intraepithelial lesions in women with genital human papillomavirus intraepithelial lesions necessary?

Introduction: There seems to be a fairly close relationship between genital and anal lesions associated with human papillomavirus (HPV) and with the pathogenesis of malignancies in such sites. Objective: This review seeks to analyze published papers that suggest the necessity for anal intraepithelial lesions screening in women with HPV genital intraepithelial lesions. Methods: A systematic review of original research published between 2001 and 2014 was performed in the databases PubMed, HighWire, Cochrane Library and Google Scholar. The keywords for the search were: “screening” or “early detection of cancer” and “anus” or “anus diseases” or “neoplasms anus” and “woman” or “women” and “HPV” or “DNA probes, HPV”. Results: 1,203 articles were selected in the first search. After the reviewers applied exclusion and inclusion criteria and analyzed the papers, 15 were selected to compose this review. Most of them showed higher rates of anal intraepithelial lesions in women with genital intraepithelial lesions than in regular women. We also found a correlation between genital neoplasms and anal infection by oncogenic HPV types and the role of the virus in the pathogenesis of anal cancer. Conclusion: Screening for anal lesions in women with HPV genital lesions should be indicated, and further studies are required to determine the best methods.

Follow up of Atypical Squamous Cell Pap Smears in Iraqi Women

To report the prevalence of atypical squamous cells of undetermined significance and atypical squamous cells-cannot exclude high squamous intraepithelial lesion and to determine the possible association of Pap test results with high-risk human papillomavirus and high squamous intraepithelial lesions in women from Duhok, Iraq. A prospective, observational study was conducted between January 2005 and December 2011. Overall, 596 women with a cervicovaginal Pap test showing atypical squamous cells of undetermined significance and 93 atypical squamous cells-cannot exclude high squamous intraepithelial lesion for whom pathologic follow-up was available were studied. Follow-up consisted of repeat cytology, colposcopy and histology. High risk human papillomavirus DNA testing was performed on exfoliated cervical cells from 106 women, using conventional PCR after at least 36 months from the initial Pap smear. Significantly high proportions of both atypical squamous cells of undetermined significance (87.9%) and atypical squamous cells-cannot exclude high squamous intraepithelial lesion (62.4%) demonstrated no significant lesion on subsequent follow up. Low squamous intraepithelial lesions were observed in 1.7% of cases of atypical squamous cells of undetermined significance and in 5.4% of atypical squamous cells-cannot exclude high squamous intraepithelial lesion. High squamous intraepithelial lesion was demonstrated in 0.8% and 16.1% respectively. In the latter there was also one case of invasive carcinoma. High-risk HPV DNA was demonstrated in 40% of atypical squamous cells of undetermined significance and 57.1% of atypical squamous cells-cannot exclude high squamous intraepithelial lesions. Since both atypical squamous cells of undetermined significance and atypical squamous cells-cannot exclude high squamous intraepithelial lesion identify patients who are at an increased risk for the development of high squamous intraepithelial lesions and a considerable percentage harbor high risk-HPV, both should be retained as diagnostic categories and patients warrant a diligent follow up and testing for high risk-HPV DNA. Colposcopic evaluation and biopsy, when indicated, are a must.

Progression and Persistence of Low-Grade Cervical Squamous Intraepithelial Lesions in Women Living With Human Immunodeficiency Virus

This study aimed to investigate the progression and persistence of low-grade squamous intraepithelial lesions (SILs) in human immunodeficiency virus (HIV)-infected women. Study participants for this retrospective cohort study were 1,720 women who had LSIL as their first abnormal Pap smear. A comparison of the survival of LSIL without progression to high-grade SIL as progression-free time and the survival of SIL without clearance of the lesion as persistence of SIL was done for women of HIV-positive, HIV-negative, or unknown status using the Kaplan-Meier method. Multivariable Cox proportional hazards regression model was applied to identify independent risk factors for disease progression or persistence. We found progression of LSIL not different between HIV groups but that persistence occurred more in HIV-positive women (63.8% vs 35.0%, p < .001). For the HIV group, antiretroviral therapy that was started before the first LSIL was associated with decreased risk for progression compared with no antiretroviral therapy (hazard ratio = 0.66, 95% CI = 0.54-0.81, p < .001). Antiretroviral therapy also improved clearance when corrected for excision treatment and age (hazard ratio = 1.71, 95% CI = 1.29-2.27, p < .001). Excision of LSIL reduced the risk of progression. In HIV-negative women, progression was reduced from 54.7% to 0.0% (p < .001), and from 46.9% to 6.4% in HIV-positive women (p < .001). Excision also reduced persistence in HIV-negative women from 39.5% to 7.1% (p = .001), but for HIV-positive women, the effect was smaller (from 66.3% to 45.5%, p < .001). Antiretroviral treatment reduced the risk for progression and persistence of LSIL in HIV-infected women.

High prevalence of cervical squamous intraepithelial lesions in women on antiretroviral therapy in Cameroon: Is targeted screening feasible?

High prevalence of cervical squamous intraepithelial lesions in women on antiretroviral therapy in Cameroon: Is targeted screening feasible?

High prevalence of cervical squamous intraepithelial lesions in women on antiretroviral therapy in Cameroon: Is targeted screening feasible?

Background: Cervical cancer is the most common cancer in women in low-income countries. Although cervical cancer incidence and mortality is higher in HIV-positive women, resource limitations restrict the implementation of systematic screening programs in these women. We explored the potential for targeted screening by assessing the prevalence, severity and predictors of cervical squamous intra-epithelial lesions (SILs) in HIV-positive women in Cameroon. Methods and findings: We conducted a cross-sectional study of women on antiretroviral therapy in Cameroon. Socio-demographic, behavioral, and clinical information was obtained from eligible women. Cervical exfoliated cells were then collected, a conventional cytology performed and epithelial lesions classified according to the Bethesda 2001 system. A total of 282 women, aged 19–68 years, were enrolled in this study. The median CD4 count was 179 cells/microliter (interquartile range: 100–271). SILs were detected in 43.5% of the 276 women with satisfactory samples: including atypical squamous cells of unknown significance (ASCUS) 0.7%, low-grade SIL (LSIL) 25.0%, atypical squamous cells, cannot exclude high grade lesions (ASC-H) 14.5%, and high-grade SIL (HSIL) 3.3%. None of the demographic or clinical characteristics considered significantly predicted the presence of any SILs or the presence of severe lesions requiring colposcopy. Conclusion: The prevalence of SIL in women on antiretroviral therapy in Cameroon was high underscoring the need for screening and care in this population. In the absence of any accurate demographic or clinical predictor of SIL, targeted screening does not seem feasible. Alternative affordable screening options need to be explored.