Ve Women Research Articles

Update on Effects of the Prophylactic HPV Vaccines on HPV Type Prevalence and Cervical Pathology.

Most national prophylactic HPV vaccination programs started in approximately 2008, with either the bivalent Cervarix HPV16/18 or quadrivalent Gardasil (HPV6/11/16/18) vaccines, which were then followed by introduction of the nonavalent Gardasil 9 (HPV6/11/16/18/ 31/33/45/52/58) vaccine from 2015. Since that time, these products have demonstrated their ability to prevent infection with vaccine-covered HPV types and subsequent development of HPV-related cervical and genital pathologies. The data indicate that vaccination of young girls prior to sexual debut is more effective than vaccination of older HPV+ve women. Although some studies have shown a decline in the prevalence of vaccine-covered HPV types, there are national and regional differences in overall vaccine efficacy. Furthermore, several recently published studies show an increase in the prevalence of non-vaccine-covered HPV types in vaccinated populations, which is indicative of HPV type-replacement. It is also notable that vaccine-related changes in HPV type prevalence spread between vaccinated and unvaccinated women at the same geographical location-presumably via sexual transmission. In conclusion, it is not yet clear what effect dissemination of vaccine-associated changes in HPV type prevalence will have on vaccine efficacy and cervical pathology, particularly in mixed populations of vaccinated and unvaccinated women. However, it is very clear these observations do underscore the need for long-term continuation of cervical screening combined with regular reassessment of testing practices.

High-risk human papillomavirus infection among Nigerian women: A systematic review and meta-analysis.

We conducted a systematic review and meta-analysis to determine the prevalence of high-risk human papillomavirus (hrHPV) infection and its associated risk factors among Nigerian women. Databases including PubMed, Web of Science, Scopus, and CINAHL were searched for studies published between 01 January 2001 and 31 December 2022, that had reported hrHPV infection and associated risk factors among women in Nigeria from ages of 25 to 65 years. Of the 136 records initially retrieved, 18 were eligible for analysis. The prevalence of hrHPV genotypes was 25%, and for hrHPV 16 and 18, were 9% and 10%, respectively. The prevalence of hrHPV among HIV+ve women was 71%. The most common risk factors for hrHPV were age at coitarche and multiple sex partners. hrHPV prevalence is high in women in Nigeria and common among those HIV+ve. Rapid screening for hrHPV genotypes is recommended, and multivalent HPV vaccines should be considered for women.

Cervical Cancer Screening Program in Bangladesh

Background: Cervical cancer (CC) is the fourth most common cancer in women worldwidewith an estimated 569,847 new cases and 311,365 deaths in the year 2018. In Bangladesh,the incidence of CC was 8068 and 5214 women died from CC in the year 2018.1CC constitutesabout 12% of the female cancer in this country.1
 Methods: The present situation of cervical cancer screening program is reviewed.
 Results: The Government of Bangladesh (GOB) adopted visual inspection of cervix withacetic acid (VIA) method for cervical cancer screening. The major strengths of VIA is itssimplicity, low cost, potential for immediate linkage with investigations/treatment, feasible inlow resource settings and the possibility of rapid training to the providers. The GOB hasextended the program to all districts and selected upazilas.The screening programme hasbeen implemented through capacity building of service providers of Medical College Hospitals(MCHs), District Hospitals (DHs), Mother and Child care Welfare Centers (MCWCs) andselected Upazila Health Compleses(UHCs) and several institutes.Serviceprovidersareperforming VIA for the women of 30 years and above at about 417 VIA centres at primary,secondary and tertiary level health care facilities of 64 districts of Bangladesh. Screen positivecases are being referred to the colposcopy clinics of 14 government MCHs and BSMMU,where evaluation and management are carried out. From January 2005 to June 2017,1647380VIA tests were performed at different facilities with 4.6%positivity.Among the VIA+ve women attending women at the colposcopy clinic of Bangabandhu Sheikh Mujib MedicalUniversity (BSMMU), 51% had precancerous or cancerous condition of the cervix, 3312(14.10%) were treated by local excision, 2428 (10.30%)by local ablative method and1413(6%) women with cervical cancer were referred to oncology. In Bangladesh, LEEPand thermalablation has acquired acceptability as a commonly used treatment method for selected CINand ‘see-and-treat’ approach for high grade diseases combining colposcopy and LEEP/thermal ablation has been adopted since the year 2010 to improve compliance to treatment.
 Conclusion: Bangladesh has established VIA as screening test for prevention of cervicalcancer in quiet a good number of facilities with wide coverage. But the program has to beexpanded readily to prevent cancer and reduce sufferings & untimely death of women dueto this devastating disease.
 Bangladesh J Obstet Gynaecol, 2018; Vol. 33(1) : 63-73

Evaluation of colposcopic and histopathological findings in precancerous cervical lesions

Background: Cervical cancer is the most frequent cancer in women worldwide. It is a preventable and curable disease with proper screening. After primary screening Colposcopy is a valuable tool in the detection and treatment of precancerous cervical lesions. Histopathology is the gold standard method of diagnosis of Precancerous lesions.
 Objective: The objective of this study was to evaluate the performance of colposcopy in the diagnosis and to make correlation between colposcopic & histopathological findings in precancerous cervical neoplasia (CIN).
 Materials and Method: It was a cross sectional study, conducted at the Colposcopy Clinic, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Study was done for a period of one year from January, 2016 to December, 2016. Sixty two married women having following complaints: positive visual inspection of cervix (VIA + ve) with 3-5% Acetic acid, postcoital bleeding, postmenopausal bleeding, and intermenstrual bleeding were recruited for the study. Written informed consent was obtained from the participants. The questionnaire was pretested, corrected and finalized. The data collection was done using the interviewer administered questionnaire. Colposcopic examination of cervix was done in 62 participants. Colposcopy guided punch biopsy/Loop electrosurgical excision procedure (LEEP) from acetowhite area was taken in cases of VIA +ve women and random four quadrants (1, 5, 7 & 11 O’ clock position) cervical biopsy in cases of VIA – ve women having other indications. Histopathological examinations of specimens were done in the Department of Pathology, BSMMU. Descriptive analysis, chi-square test (X2) and Fisher’s exact test were performed. P value<0.05 was taken as statistically significant.
 Result: The mean age of the study population was 36.8±11.9 years ranging from 20 to72 years. Out of 62 participants, 40.3% (n=25) had VIA positive, 41.9% (n=26) had postcoital bleeding among which 24 was VIA positive and 2 was VIA negative, 8.1% (n=5) had intermenstrual bleeding with positive VIA and 9.7% (n=6) post-menopausal bleeding among which 4 was VIA positive and 2 was VIA negative. Among total 62 participants
 Sensitivity of colposcopy to diagnose histopathologically confirmed CIN I was 82.6%, CIN II was 25% and CIN III was also 25%. The specificity to diagnose CIN I was 42.4%, CIN II was 91.4% and CIN III was 93.1%. PPV of colposcopy to diagnose histologically confirmed CIN I was 55.8%, CIN II was 16.7% and CIN III was 20%. The NPV to diagnose CIN I was 73.7%, CIN II was 94.6% and CIN III was 94.7%. The colposcopic accuracy to diagnose CIN I was 61.3%, CIN II was 87.1% and CIN III was 90.3%. There was statistically significant (P value <0.05) correlation for colposcopic diagnosis of histopathologically confirmed CIN I,CIN II and III.
 Conclusion: The accuracy of colposcopy to diagnose histopathologically confirmed precancerous cervical lesions was quite high. Patients presenting with postcoital bleeding and postmenopausal bleeding should have colposcopy and biopsies even if the screening test result normal. Moreover colposcopy has high sensitivity, so we can easily adopt the see and treat method to reduce the dropout.
 Bangladesh Med Res Counc Bull 2020; 46(1): 48-54

Targeted Antenatal Screening for Predicting Postpartum Thyroiditis and Its Evolution Into Permanent Hypothyroidism.

Postpartum thyroiditis (PPT) has a prevalence of 1–22%, with an ~50% rate of evolution into permanent hypothyroidism (PH). PPT risk is assessed by measuring serum thyroid antibodies during gestation, as 1/3–1/2 of Ab+ve pregnant women will develop PPT. Family and personal history positive for autoimmune non-thyroid diseases (AINTDT), and consumption of swordfish increases while consumption of small oily fish decreases the risk of PPT. Monitoring thyroid function in a very high-risk subgroup avoids the costs of the Ab-based universal screening. We aimed at identifying such subgroup in 412 women followed from week 7–11 of gestation to month 12 postpartum. At study entry, we measured serum TPOAb, TgAb, TSH, FT4, FT3, and evaluated seafood consumption, familial history for thyroid diseases and AINTD, and personal history for AINTD. We measured TSH, FT4, FT3 at 1.5, 3, 6, and 12 months postpartum. PPT occurred in 63 women (15.3%), and PH in 34/63 (54%). Based on positivity/negativity for the three histories, women were classified into 8 categories, with PPT rates of 3.8–100%. Seafood consumption allowed further separation of subgroups having different PPT risks. We considered 11 possible strategies, termed [a] through [k]. Strategy [a] consisted in omitting gestational screening, while performing universal postpartum monitoring with TSH and one thyroid hormone; strategy [k] consisted in selective gestational screening with TPOAb and TgAb, based on history and fish consumption, and selective postpartum monitoring in TPOAb and/or TgAb+ve women. The 100% sensitivity, specificity and diagnostic accuracy of strategy [a] were counterbalanced by the highest costs (Euro 32,960 or 523 per each PPT caught). The corresponding numbers for strategy [k] were 78, 95, 93%, and Euro 8,920 or 182/PPT caught. These savings stem from gestational screening being done in 186 women, and postpartum monitoring done in 65/186 women. One gestational screning-free strategy was the cheapest (Euro 2,080 or 83/PPT caught), because based on postpartum monitoring of only 26 women, but had the lowest sensitivity (40%). Identification of pregnant women having different risks for PPT is feasible, with the costless evaluation of history and seafood consumption driving gestational screening of thyroid antibody status and postpartum monitoring of thyroid function.

Assessment of serum thyroid hormone autoantibodies in the first trimester of gestation as predictors of postpartum thyroiditis

BackgroundMeasurement of serum thyroperoxidase autoantibodies (TPOAb) during gestation as a classical marker for the risk of postpartum thyroiditis (PPT) predicts PPT in 1/3 to 1/2 of women. Very few studies have measured serum thyroid hormone Ab (THAb) during gestation, and none as a possible marker for PPT. MethodsIn 412 women who were followed up from 7 to 11 weeks of gestation through 12 months after delivery, we measured THAb (T3.IgM, T3.IgG, T4.IgM, T4.IgG), thyroglobulin autoantibodies (TgAb) and TPOAb at study entry (7–11 week of gestation). ResultsSixty-three women (15.3%) developed PPT, which progressed to permanent hypothyroidism (PH) in 34/63 (54%). THAb+ve were 21/412 women (5.1%), the frequency being greater in those who then developed PPT (12/63 [19.0%] vs. 9/349 [2.6%], P = 4.6 × 10−8), and in the PH subgroup (26.5% [9/34] vs. 10.3% [10/29], P = 0.12). THAb positivity occurred in 9/76 women (11.8%) who were TgAb and/or TPOAb+ve compared to 12/336 women who were TgAb and TPOAb negative (3.6%, P = 0.0031). Of these 9 THAb+ve, TgAb and/or TPOAb+ve women, all (100%) developed PPT compared to 3/11 (27.3%, P = 0.0011) THAb+ve, TgAb and/or TPOAb negative women. Of these 9 and 3 PPT women, 8 and 1 progressed to PH (88.9% and 33.3%, respectively, P = 0.12). ConclusionsGestational positivity of THAb enhance enormously the predictivity for PPT of gestational positivity of TPOAb/TgAb. However, their low frequency (5.1%) and their sensitivity (17.5% [21/63]) go against their application in lieu of TPOAb/TgAb.

Effect of Rhesus Negative in Pregnancy

Hemolytic disease of the newborn due to Rhisoimmunisation is a major cause to perinatal morbidity & mortality. Erythroblastosis fetalis is a disease of fetus and newborn due to incompatibility between fetal and maternal blood group. Diagnosis and therapy for Rh immunization improved considerably. Its prevention by immunoprophylaxis has been responsible for the reduction in the incidence of perinatal mobility. Still Rh immunization and erythroolastosis fetalis is responsible for many obstetric mishaps in our country. To see the pregnancy outcome of Rhesus negative women. This prospective study was carried out from October 2013 to March 2014 in Obstetrics & Gynecology department of Sylhet MAG Osmani Medical College & Hospital, Sylhet. 50 Rh-negative pregnancies were selected those who got admitted in department of Obstetrics & Gynecology, SOMCH. 30.62% of the fetuses had blood group B+ve, 24.40% 0+ve and 20.40% A+ve. Regarding the perinatal outcome 76% were healthy, 4% still birth, 4% neonatal death, 14% with erythroblastosis foetalis and 4% developed hydrops. Mild anaemia and oedema was common in primi and multigravida patients. PET was found 6.2% in multigravida patients. APH and Hydramnios with congenital anomalies were 3.1% and 3.1% respectively. This study was undertaken to evaluate the outcome of pregnancy in Rh -ve women. It is preventable. Primary prevention of isoimmunization by giving combined antenatal and postnatal prophylaxis.Medicine Today 2018 Vol.30(1): 23-25

Role of kidney biomarkers [Kidney injury molecule-1, Calbindin, Interleukin-18 and Monocyte chemoattractant protein-1] in HIV associated pre-eclampsia

ABSTRACTObjective: Both HIV infection and pre-eclampsia (PE) are associated with considerable maternal mortality in South Africa. This study was designed to compare the urinary levels of kidney injury molecule-1 (KIM-1), calbindin, interleukin-18 (IL-18), and monocyte chemoattractant protein-1 (MCP-1) in HIV associated normotensive and preeclamptic pregnancies.Methods: Following ethical approval and written consent, urine samples were collected from HIV negative (HIV –ve) normotensive pregnant (n = 19), HIV positive (HIV +ve) normotensive pregnant (n = 19), HIV –ve pre-eclamptic (n = 19) and HIV +ve pre-eclamptic (n = 19) women. The concentrations of KIM-1, calbindin, IL-18 and MCP-1 were assessed using the Bioplex technology.Results: In contrast to IL-18 (p > 0.05) and MCP-1 (p > 0.05), the concentrations of KIM-1 (p = 0.02) and calbindin (p = 0.02) were significantly higher in PE compared to normotensive pregnancies, irrespective of HIV status. Based on HIV status, all 4 analytes were similar between HIV+ve and HIV-ve groups. Urinary KIM-1 levels in the HIV –ve pre-eclamptics were significantly higher than those in the HIV –ve women with normal pregnancies (p = 0.007). The maternal hypertension and/or HIV profile has no marked impact on the fetal weight.Conclusion: Our results demonstrate an increase in the urinary level of kidney injury molecule-1 and calbindin in PE, implicating their possible value as biomarkers of kidney injury. We observed no differences in the levels of KIM-1, IL-18, MCP-1 and calbindin based on HIV status. We propose that studies with larger sample sizes using these markers be conducted to establish their use as markers of diagnosing kidney injury in PE.

As mulheres da Reforma na Igreja do norte da Alemanha: um olhar sob a perspectiva de gênero

O artigo aborda o tema das mulheres da Reforma desde o século XVI até hoje, propondo uma análise de gênero. Para tanto, é apresentado inicialmente o projeto da exposição itinerante organizada pelo Departamento de Mulheres da Igreja do Norte da Alemanha. A exposição define como mulheres da Reforma aquelas que, ao darem o seu testemunho de fé, contribuíram ativamente para a promoção das ideias de uma igreja sempre em Reforma. A compreensão da Reforma como um processo contínuo extende o movimento histórico desde o século XVI até hoje. A segunda parte do artigo apresenta cinco biografiasde mulheres incluídas na exposição em forma de resumo. As biografi as narram histórias de mulheres que deram testemunho de fé de forma inovadora, marcando a história da sua região. A terceira parte do artigo realiza uma análise de gênero a partir das mudanças propostas pelo movimento da Reforma aos papéis do masculino e do feminino na sociedade no século XVI. Também são incluídas na análise as situações trazidas pelas biografias, que descrevem enfrentamentos pela liderança de comunidades e no trabalho social, bem como conquistas.

Analysis of the Prevalence of HTLV-1 Proviral DNA in Cervical Smears and Carcinomas from HIV Positive and Negative Kenyan Women

The oncogenic retrovirus human T-cell lymphotropic virus type 1 (HTLV-1) is endemic in some countries although its prevalence and relationship with other sexually transmitted infections in Sub-Saharan Africa is largely unknown. A novel endpoint PCR method was used to analyse the prevalence of HTLV-1 proviral DNA in genomic DNA extracted from liquid based cytology (LBC) cervical smears and invasive cervical carcinomas (ICCs) obtained from human immunodeficiency virus-positive (HIV+ve) and HIV-negative (HIV−ve) Kenyan women. Patient sociodemographic details were recorded by structured questionnaire and these data analysed with respect to HIV status, human papillomavirus (HPV) type (Papilocheck®) and cytology. This showed 22/113 (19.5%) of LBC’s from HIV+ve patients were positive for HTLV-1 compared to 4/111 (3.6%) of those from HIV−ve women (p = 0.0002; odds ratio (OR) = 6.42 (2.07–26.56)). Only 1/37 (2.7%) of HIV+ve and none of the 44 HIV−ve ICC samples were positive for HTLV-1. There was also a significant correlation between HTLV-1 infection, numbers of sexual partners (p < 0.05) and smoking (p < 0.01). Using this unique method, these data suggest an unexpectedly high prevalence of HTLV-1 DNA in HIV+ve women in this geographical location. However, the low level of HTLV-1 detected in HIV+ve ICC samples was unexpected and the reasons for this are unclear.

Linking HIV & family planning services to improve dual methods of contraception among women infected with HIV in Mumbai, Maharashtra, India.

Background & objectives:Preventing unintended pregnancies among people living with HIV (PLHIV) is one of the strategies of WHO for preventing parent-to-child transmission (PPTCT). Given the limitation of only condom use, the objective of this study was to improve use of dual contraceptive methods among HIV infected women.Methods:An experimental study among HIV positive women was conducted at two tertiary care level hospitals in Mumbai. Linking HIV with family planning services was the focus of intervention at one site and standard level of care was maintained at the control site. At each site, 150 HIV+ve women attending counselling and testing centres, who did not intend to get pregnant in the next one year and were eligible to use dual methods, were enrolled and followed up to one year.Results:At the end of one year, 60 per cent women in the intervention group reached Family Planning Centres compared to eight per cent in the control group. There was three times more acceptance and continuation of use of dual methods along with increase in consistent use of condoms and less number of unplanned pregnancies in the intervention group than the control group.Interpretation & conclusions:The study findings demonstrate that linking HIV and family planning services may facilitate the uptake of dual methods of contraception without reducing consistent condom use among HIV infected women. The PPTCT programmes need to focus on the component of Prong 2 of PPTCT which aims to prevent unintended pregnancies among HIV positive women.

Increased cycling cell numbers and stem cell associated proteins as potential biomarkers for high grade human papillomavirus+ve pre-neoplastic cervical disease.

High risk (oncogenic) human papillomavirus (HPV) infection causes cervical cancer. Infections are common but most clear naturally. Persistent infection can progress to cancer. Pre-neoplastic disease (cervical intraepithelial neoplasia/CIN) is classified by histology (CIN1-3) according to severity. Cervical abnormalities are screened for by cytology and/or detection of high risk HPV but both methods are imperfect for prediction of which women need treatment. There is a need to understand the host virus interactions that lead to different disease outcomes and to develop biomarker tests for accurate triage of infected women. As cancer is increasingly presumed to develop from proliferative, tumour initiating, cancer stem cells (CSCs), and as other oncogenic viruses induce stem cell associated gene expression, we evaluated whether presence of mRNA (detected by qRT-PCR) or proteins (detected by flow cytometry and antibody based proteomic microarray) from stem cell associated genes and/or increased cell proliferation (detected by flow cytometry) could be detected in well-characterised, routinely collected cervical samples from high risk HPV+ve women. Both cytology and histology results were available for most samples with moderate to high grade abnormality. We found that stem cell associated proteins including human chorionic gonadotropin, the oncogene TP63 and the transcription factor SOX2 were upregulated in samples from women with CIN3 and that the stem cell related, cell surface, protein podocalyxin was detectable on cells in samples from a subset of women with CIN3. SOX2, TP63 and human gonadotrophin mRNAs were upregulated in high grade disease. Immunohistochemistry showed that SOX2 and TP63 proteins clearly delineated tumour cells in invasive squamous cervical cancer. Samples from women with CIN3 showed increased proliferating cells. We believe that these markers may be of use to develop triage tests for women with high grade cervical abnormality to distinguish those who may progress to cancer from those who may be treated more conservatively.

Effect of low-dose selenium on thyroid autoimmunity and thyroid function in UK pregnant women with mild-to-moderate iodine deficiency.

PurposeSelenium is an essential trace mineral and a component of selenoproteins that are involved in the production of thyroid hormones and in regulating the immune response. We aimed to explore the effect of low-dose selenium supplementation on thyroid peroxidase antibody (TPO-Ab) concentration and thyroid function in pregnant women from a mild-to-moderate iodine-deficient population.MethodsSamples and data were from a secondary analysis of Selenium in PRegnancy INTervention (SPRINT), a double-blind, randomized, placebo-controlled study that recruited 230 women with singleton pregnancies from a UK antenatal clinic at 12 weeks of gestation. Women were randomized to receive 60 µg/day selenium or placebo until delivery. Serum thyroid peroxidase antibodies (TPO-Ab), thyrotropin (TSH) and free thyroxine (FT4) were measured at 12, 20 and 35 weeks and thyroglobulin antibodies (Tg-Ab) at 12 weeks.Results93.5 % of participants completed the study. Se supplementation had no more effect than placebo in decreasing TPO-Ab concentration or the prevalence of TPO-Ab positivity during the course of pregnancy. In women who were either TPO-Ab or Tg-Ab negative at baseline (Thy-Ab−ve), TSH increased and FT4 decreased significantly throughout gestation (P < 0.001), with no difference between treatment groups. In women who were Thy-Ab+ve at baseline, TSH tended to decrease and was lower than placebo at 35 weeks (P = 0.050). FT4 fell more on Se than placebo supplementation and was significantly lower at 35 weeks (P = 0.029).ConclusionsLow-dose selenium supplementation in pregnant women with mild-to-moderate deficiency had no effect on TPO-Ab concentration, but tended to change thyroid function in Thy-Ab+ve women.

Glutamic acid decarboxylase autoantibody-positivity post-partum is associated with impaired β-cell function in women with gestational diabetes mellitus.

To investigate whether the presence of glutamic acid decarboxylase (GAD) autoantibodies post-partum in women with prior gestational diabetes mellitus was associated with changes in metabolic characteristics, including β-cell function and insulin sensitivity. During 1997-2010, 407 women with gestational diabetes mellitus were offered a 3-month post-partum follow-up including anthropometrics, serum lipid profile, HbA1c and GAD autoantibodies, as well as a 2-h oral glucose tolerance test (OGTT) with blood glucose, serum insulin and C-peptide at 0, 30 and 120 min. Indices of insulin sensitivity and insulin secretion were estimated to assess insulin secretion adjusted for insulin sensitivity, disposition index (DI). Twenty-two (5.4%) women were positive for GAD autoantibodies (GAD+ve) and the remainder (94.6%) were negative for GAD autoantibodies (GAD-ve). The two groups had similar age and prevalence of diabetes mellitus. Women who were GAD+ve had significantly higher 2-h OGTT glucose concentrations during their index-pregnancy (10.5 vs. 9.8 mmol/l, P = 0.001), higher fasting glucose (5.2 vs. 5.0 mmol/l, P = 0.02) and higher 2-h glucose (7.8 vs. 7.1 mmol/l, P = 0.05) post-partum. Fasting levels of C-peptide and insulin were lower in GAD+ve women compared with GAD-ve women (520 vs. 761 pmol/l, P = 0.02 and 33 vs. 53 pmol/l, P = 0.05) Indices of insulin sensitivity were similar in GAD+ve and GAD-ve women, whereas all estimates of DI were significantly reduced in GAD+ve women. GAD+ve women had higher glucose levels and impaired insulin secretion adjusted for insulin sensitivity (DI) compared with GAD-ve women. The combination of OGTT and GAD autoantibodies post-partum identify women with impaired β-cell function. These women should be followed with special focus on development of Type 1 diabetes.

Assessing the impact of counseling HTLV-1 seropositive women on vertical transmission in the GIPH cohort study, Brazil

HTLV-1 is endemic in Brazil and is associated with major illnesses (HAM/TSP, ATL and uveitis). Since the infection remains asymptomatic in the majority of cases and screening is only performed in blood banks, there is an ongoing vertical transmission that remains unnoticed by the public health system. Although recommended by Brazilian researchers of the field, the prenatal screening for HTLV-1 or 2 was not yet implemented throughout the country. We performed a cross-sectional analysis to verify the impact of counseling HTLV-1 seropositi ve women in childbearing age participating in the GIPH cohort. The counseling included recommendations of not breastfeeding, giving infant formula and preferably having the child delivered by cesarean section. Children born from HTLV-1 seropositive women were divided in two groups: (1) born before and (2) after the participation of mothers in the GIPH cohort (“GIPH babies”). We have identified 21 children born to HTLV-1 positive mothers who received no counseling and 18 “GIPH babies”, born from mothers who received counseling. 3/21 (14.3%) and 1/18 (5.6%) of the children were found positive for HTLV-1. The numbers will be expanded with active search of the remaining children not yet tested (n=15). Although the numbers are still preliminary, they point to a trend of successful counseling and avoidance of transmission of the virus. These actions should be widespread in the country to avoid the silent transmission of the virus.

Variation of Transaminases, HCV-RNA Levels and Th1/Th2 Cytokine Production during the Post-Partum Period in Pregnant Women with Chronic Hepatitis C

This study analyses the evolution of liver disease in women with chronic hepatitis C during the third trimester of pregnancy and the post-partum period, as a natural model of immune modulation and reconstitution. Of the 122 mothers recruited to this study, 89 were HCV-RNA+ve/HIV-ve and 33 were HCV-RNA-ve/HIV-ve/HCVantibody+ve and all were tested during the third trimester of pregnancy, at delivery and post-delivery. The HCV-RNA+ve mothers were categorized as either Type-A (66%), with an increase in ALT levels in the post-partum period (>40 U/L; P<0.001) or as Type-B (34%), with no variation in ALT values. The Type-A mothers also presented a significant decrease in serum HCV-RNA levels in the post-delivery period (P<0.001) and this event was concomitant with an increase in Th1 cytokine levels (INFγ, P = 0.04; IL12, P = 0.01 and IL2, P = 0.01). On the other hand, the Type-B mothers and the HCV-RNA-ve women presented no variations in either of these parameters. However, they did present higher Th1 cytokine levels in the partum period (INFγ and IL2, P<0.05) than both the Type-A and the HCV-RNA-ve women. Cytokine levels at the moment of delivery do not constitute a risk factor associated with HCV vertical transmission. It is concluded that differences in the ALT and HCV-RNA values observed in HCV-RNA+ve women in the postpartum period might be due to different ratios of Th1 cytokine production. In the Type-B women, the high partum levels of Th1 cytokines and the absence of post-partum variation in ALT and HCV-RNA levels may be related to permanent Th1 cytokine stimulation.

Role of Print and Audiovisual Media in Cervical Cancer Prevention in Bangladesh

Visual inspection of cervix with acetic acid (VIA) is offered at 252 centers in 64 districts of Bangladesh. VIA+ve women are managed at colposcopy clinics of Bangabandhu Sheikh Mujib Medical University (BSMMU) and 14 Medical College Hospitals (MCHs). This research work has been supported by 'UICC Cancer Prevention Campaign' programme. This study explored the role of print materials and electronic media to improve cervical cancer screening in the present socio-cultural context of Bangladesh. This study was performed from January to August 2011 at two upazilas of Bangladesh (Singair with screening facility and Sonargaon without screening facility). Data were collected by focus group discussion (FGD) with women, husbands and community people before and after intervention. Information on cervical cancer screening and VIA camps was disseminated using advertisement through local cable line of the television, microphone announcement, service providers and leaflet throughout the week prior to a VIA camp. Three-day VIA camps were organized at the upazila health complex (UHC) of both upazilas. Quantitative data was gathered from women at the camps on source of information on VIA and the best method of awareness creation. The population was aware of "cancer" and a notable number knew about cervical cancer. Baseline awareness on prevention and VIA was low and it was negligible where screening services were unavailable. Awareness was increased fourfold in both upazilas after interventions and half of the women and the majority of the community people became aware of screening and available facilities. Cable line advertisement (25.5%), microphone announcement (21.4%), and discussion sessions (20.4%) were effective for awareness creation on VIA. Television was mentioned as the best method (37.4%) of awareness creation. Television should be used for nation-wide awareness creation. For local awareness creation, cable line advertisement, microphone announcements and health education at Uthan Baithaks/ EPI sessions can easily be adopted by the government.

Long-term HIV infection and antiretroviral therapy are associated with bone microstructure alterations in premenopausal women

We evaluated the influence of long-term HIV infection and its treatment on distal tibia and radius microstructure. Premenopausal eumenorrheic HIV-positive women displayed trabecular and cortical microstructure alterations, which could contribute to increased bone fragility in those patients. Bone fragility is an emerging issue in HIV-infected patients. Dual-energy X-ray absorptiometry (DXA) quantified areal bone mineral density (BMD) predicts fracture risk, but a significant proportion of fracture risk results from microstructural alterations. We studied the influence of long-term HIV infection on bone microstructure as evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 22 HIV-positive (+ve) premenopausal eumenorrheic women and 44 age- and body mass index (BMI)-matched HIV-negative (-ve) controls. All subjects completed questionnaires regarding calcium/protein intakes and physical activity, and underwent DXA and HR-pQCT examinations for BMD and peripheral skeleton microstructure, respectively. A risk factor analysis of tibia trabecular density using linear mixed models was conducted. In HIV+ve women on successful antiretroviral therapy (undetectable HIV-RNA, median CD4 cell count, 626), infection duration was 16.5 ± 3.5 (mean ± SD) years; median BMI was 22 (IQR, 21-26) kg/m². More HIV+ve women were smokers (82 versus 50 %, p = 0.013). Compared to controls, HIV+ve women had lower lumbar spine (spine T-score -0.70 vs -0.03, p = 0.014), but similar proximal femur BMD. At distal tibia, HIV+ve women had a 14.1 % lower trabecular density and a 13.2 % reduction in trabecular number compared to HIV-ve women (p = 0.013 and 0.029, respectively). HR-pQCT differences in distal radius were significant for cortical density (-3.0 %; p = 0.029). Compared with HIV-ve subjects, premenopausal HIV+ve treated women had trabecular and cortical bone alterations. Adjusted analysis revealed that HIV status was the only determinant of between group tibia trabecular density differences. The latter could contribute to increased bone fragility in HIV+ve patients.

P3-S1.35 Systemic and mucosal IgG and IgA antibody responses in genital Chlamydia trachomatis infection

BackgroundChlamydia trachomatis (CT) is the most common sexually transmitted infection in the UK. Screening and treatment programmes do not appear to have reduced the population levels of Chlamydia. Ideally a...

Abstract PD03-04: Effects of Diabetes (DM), Hypertension (HTN) and Coronary Artery Disease (CAD) on Prognosis after 5 Years of Adjuvant Tamoxifen (TAM) and on Treatment Outcomes with the Use of Extended Letrozole (LET): NCIC CTG MA.17

Abstract Background: Women with early stage breast cancer and DM have poorer survival compared to non-DM women (Lipscombe 2008). Mechanisms include insulin dysregulation and/or DM related comorbidities such as HTN and CAD. MA.17 showed that adjuvant LET after five yrs of TAM reduced the risk of recurrence in women with ER+ early stage breast cancer and improved survival in node +ve disease. We evaluated the impact of DM, HTN, or CAD on prognosis after 5 yrs of TAM and the efficacy of LET in MA.17. Methods: All 5170 women randomized to MA.17 were included. Four year disease free survival (DFS), distant disease free survival (DDFS) and overall survival (OS) were compared using Cox regression model adjusting for other prognostic factors: a) in women treated with placebo (PLAC) based on the presence or absence of baseline DM (n=462), HTN (n=1627), CAD (n=604) or any one of these comorbidities (n=2049), and b) between LET and PLAC groups in each comorbidity. Analyses based on nodal status were also performed. Test for interaction assessed for differential treatment effects in comorbidity groups. Results: Women with DM on PLAC had non-significant lower DFS (89.7 vs. 89.9%, p=0.68), DDFS (92.1 vs 93.9%, p=0.85), and OS (92.1 vs 95.2, p=0.37) than those without DM on PLAC. Treatment effect outcomes were similar between those with and without DM. Women with HTN on PLAC trended toward lower DDFS (92.2 vs 94.4%, HR=1.50, 95%CI: 0.98-2.3, p=0.06) and OS (93.7 vs. 95.5%, HR=1.61, 95%CI: 0.95-2.72, p=0.08) than non-HTN women on PLAC. The interaction between treatment and HTN status was significant for DDFS (p=0.004) with HTN women having significantly better outcome on LET vs PLAC (HR=0.27, 95%CI: 0.13 to 0.54; p=0.0002) compared to non-HTN women on LET vs PLAC (HR=0.82, 95%CI: 0.56-1.20; p=0.31). Women with CAD on PLAC did not have worse outcome, nor did CAD status have a treatment related effect. Women with at least one co-morbidity on PLAC had significantly lower OS (93.6 vs. 95.8%, HR=2.10, 95%CI:1.26-3.51, p=0.004) than those free of comorbidity. For node +ve women, the difference between LET and PLAC in DDFS was greater among women with at least one co-morbidity (HR=0.30, 95%CI:0.15-0.60, p=0.001) compared to those without any co-morbidity (HR=0.72, 95%CI:0.45-1.16, p=0.17) with interaction p=0.04. Conclusions: Having at least one comorbidity was a negative prognostic indicator for OS after 5 yrs of TAM and led to improved DDFS for node +ve women taking LET. DM was not prognostic nor did it predict treatment outcomes. Explanations include not controlling for DM medications; as well, MA.17 enrolled women 5 yrs after TAM with evidence suggesting hyperinsulinemia being a risk for early rather than late recurrence. HTN was a potential risk factor with a trend for worse DDFS and OS. HTN also predicted for treatment benefit: HTN women on LET had improved DDFS compared to non-HTN women on LET. Hypothesis include antihypertensive agents slowing the metabolism of LET; alternatively there may be variations in VEGF levels between groups. HTN predictive effects will be further explored in MA.27 with potential to correlate with VEGF levels. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD03-04.