Cervical cancer risk factors among HIV-infected Nigerian women

Abstract

BackgroundCervical cancer is the third most common cancer among women worldwide, and in Nigeria it is the second most common female cancer. Cervical cancer is an AIDS-defining cancer; however, HIV only marginally increases the risk of cervical pre-cancer and cancer. In this study, we examine the risk factors for cervical pre-cancer and cancer among HIV-positive women screened for cervical cancer at two medical institutions in Abuja, Nigeria.MethodsA total of 2,501 HIV-positive women participating in the cervical cancer screen-and-treat program in Abuja, Nigeria consented to this study and provided socio-demographic and clinical information. Log-binomial models were used to calculate relative risk (RR) and 95% confidence intervals (95%CI) for the risk factors of cervical pre-cancer and cancer.ResultsThere was a 6% prevalence of cervical pre-cancer and cancer in the study population of HIV-positive women. The risk of screening positivity or invasive cancer diagnosis reduced with increasing age, with women aged 40 years and older having the lowest risk (RR=0.4; 95%CI=0.2–0.7). Women with a CD4 count of 650 per mm3 or more also had lower risk of screening positivity or invasive cancer diagnosis (RR=0.3, 95%CI=0.2–0.6). Other factors such as having had 5 or more abortions (RR=1.8, 95%CI=1.0–3.6) and the presence of other vaginal wall abnormalities (RR=1.9, 95%CI=1.3–2.8) were associated with screening positivity or invasive cancer diagnosis.ConclusionThe prevalence of screening positive lesions or cervical cancer was lower than most previous reports from Africa. HIV-positive Nigerian women were at a marginally increased risk of cervical pre-cancer and cancer. These findings highlight the need for more epidemiological studies of cervical cancer and pre-cancerous lesions among HIV-positive women in Africa and an improved understanding of incidence and risk factors.

Sociodemographic determinants of abnormal cervical cytology among HIV positive women in Nnewi, Nigeria

“…However, the finding is in contrast to the reports of Liu et al (2016) in Tanzanian and Ononogbu et al (2013) in Abuja, Nigeria who found a significant association between increasing age and the risk of developing premalignant lesions of the cervix among the women.…”

“…Similarly, Ononogbu et al (2013) studied 2501 HIV positive women in Abuja, Nigeria and reported that increasing age and age >40 years were associated with reduced risk of developing premalignant lesions of the cervix among the women.…”

Implementation and Operational Research

“…12 The younger age of presentation of ICC among HIV-seropositive women has been also reported in several smaller studies in sub-Saharan Africa. 13–15,29,30 However, in a study done in Dakar, Senegal, an increase in ICC was noted only in women above the reproductive age, 55 years and above. 28 This is perhaps due to the higher prevalence of HIV-2 in this population (compared with HIV-1, which is more prevalent in Southern Africa); since HIV-2 has a long latent period and slower progression to AIDS.…”

“…9–11 It has been reported from previous smaller and retrospective studies from sub-Saharan Africa that HIV-seropositive women typically present with ICC at an earlier age. 12–15 This likely results from a more rapid progression of chronic persistent human papillomavirus infection in this subpopulation, modulated by a relative immunosuppressive state (even while accessing ART), 16,17 and is further accentuated by the limited or nonexistent access to cervical cancer screening services.…”

Challenges in the Detection, Prevention, and Treatment of HIV-Associated Malignancies in Low- and Middle-Income Countries in Africa

“…Cancer prevention initiatives that harness HIV treatment and prevention programs are likely to be the most cost effective and also to have the broadest impacts. 21-23 The increased professional and public awareness of cancer in LMICs as a treatable and preventable comorbidity in people with controlled HIV infection is likely to have spin-off benefits to the general population by strengthening general oncologic practice and cancer registration, increasing our understanding of the spectrum of cancers, and characterizing trends in cancer incidence. 24 …”