Faisabilité du frottis cervico-utérin chez les femmes séropositives pour le VIH vivant au Tchad

Abstract

Cervical cancer is the leading cause of cancerrelated death in Sub-Saharan African women. HIV-infected women are at increased risk for cervical intraepithelial lesions and invasive cervical cancer. WHO guidelines for screening and treatment of precancerous cervical lesions are regularly actualized. There are no data on cervical squamous intraepithelial lesions in Chad. Between August 2013 and May 2015, screening for cervical squamous intraepithelial lesions was proposed to HIV-infected women living in Moundou (Chad). Cytology examination was performed after with Papanicolaou coloration. Three hundred and eleven HIV-seropositive women accepted the screening without refusal. Mean age of the patients was 38 years (95% Confidence Interval: 37.7-39.9). The women declared a mean of 4.1 pregnancies (range: 0-12). The patients had been followed-up for their seropositivity for 8 years (range: 0-25). All were on highly active antiretroviral therapy (HAART). Of the patients whose results were known (N = 231), 98% had a CD4 lymphocyte nadir count less than 350/mm(3). Cytological results were as follows: normal smear (N = 59; 19%), inflammatory or hemorrhagic smear (N = 139; 44%), low grade squamous intraepithelial lesion (N = 58; 19%), high grade squamous intraepithelial lesion (N = 28; 9%), epidermoid carcinoma (N = 13; 4%), and uninterpretable smear (N = 14; 5%). The inflammatory lesions were due to cervicitis (N = 54), vaginosis (N = 22), and trichomonas infection (N = 3). The patients' age, CD4 lymphocyte nadir count, and CD4 count at the time of the cervical smear were not different according to the cytological results. Only five patients had a cone biopsy. Three patients deceased during the study of whom two from a gynaecological cancer diagnosed too late. The screening of dysplasia and cervical cancer in HIV-seropositive women is possible in Chad. In our study, 13% of the women had highgrade dysplasia or carcinoma needing curative care. We also showed that simple cytology did not permit the interpretation of half of the smears. The performance of cervical smear would have increased if it had been preceded by the visualization of the cervix with coloration.

Low Prevalence of Common Sexually Transmitted Infections Contrasting with High Prevalence of Mycoplasma Asymptomatic Genital Carriage: A Community-Based Cross-Sectional Survey in Adult Women Living in N’Djamena, Chad

“…Epidemiological data on the prevalence of common bacterial STIs in Chad has been poorly reported until now. In a cohort of 311 HIV-1-seropositive women, Mortier and colleagues found a prevalence of 1% for T. vaginalis [13]. To our knowledge, our observations are the first ones for N. gonorrhea, C. trachomatis, M. genitalium as well as for genital mycoplasmas in adult women living in Chad.…”

High prevalence of cervical high-risk human papillomavirus infection mostly covered by Gardasil-9 prophylactic vaccine in adult women living in N’Djamena, Chad

“…Therefore, there is an urgent need for implementing a cervical cancer prevention program in Chad, as recommended by the WHO [59]. According to Mortier and colleagues, the cytology-based cervical cancer screening in women in Chad is feasible with low cost and easy to interpret visual technics; and could be integrated in existing healthcare structures [25]. Indeed, for these women carrying cervical HR-HPV infection, only secondary prevention with regular screening for precancerous lesions by cytology and the monitoring of the viral persistence by HPV molecular testing, remains the only alternative to prevent the disease progression into invasive cervical cancer.…”

“…In Chad, a country of around 15 million people, including more than 3 million women aged more than 25 year-old [22, 23], no significant progress has been realized until now in cervical cancer prevention [24, 25]. Only one pilot study assessing the feasibility of the cytology-based screening for cervical lesions in HIV-infected women has been conducted in Chad [25].…”

“…In Chad, a country of around 15 million people, including more than 3 million women aged more than 25 year-old [22, 23], no significant progress has been realized until now in cervical cancer prevention [24, 25]. Only one pilot study assessing the feasibility of the cytology-based screening for cervical lesions in HIV-infected women has been conducted in Chad [25]. Thus, HIV-infected Chadian women were at high-risk for low and high-grade cervical lesions, suggesting indirectly a high and unsuspected burden of cervical HPV infection in Chad [25].…”

“…Only one pilot study assessing the feasibility of the cytology-based screening for cervical lesions in HIV-infected women has been conducted in Chad [25]. Thus, HIV-infected Chadian women were at high-risk for low and high-grade cervical lesions, suggesting indirectly a high and unsuspected burden of cervical HPV infection in Chad [25]. In addition, primary prevention by prophylactic vaccine could likely constitute one of the best options for many women in Chad, who will likely not have the luxury of diagnostic exams and care.…”