Incidence and progression of cervical lesions in women with HIV: a systematic global review

Denslow, Sheri; Rositch, Anne F.; Firnhaber, Cynthia; Ting, Jie; Smith, Jennifer S.

doi:10.1177/0956462413491735

Cited by 144 publications

(167 citation statements)

References 47 publications

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“…8,9 A recent systematic global review 10 looking at the incidence and progression of cervical lesions in women with HIV showed that HIV-infected women had a median 3-fold higher incidence of cervical lesions compared to HIV-negative women. It also reported that HIV-positive women were at least twice as likely to have cervical lesions that progressed in severity to HIV-negative women, although this did not reach statistical significance due to sample size.…”

mentioning

confidence: 99%

Progression and Regression of Cervical Pap Test Lesions in an Urban AIDS Clinic in the Combined Antiretroviral Therapy Era: A Longitudinal, Retrospective Study

Lofgren

Tadros

Herring-Bailey

et al. 2015

AIDS Research and Human Retroviruses

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Our objective was to evaluate the progression and regression of cervical dysplasia in human immunodeficiency virus (HIV)-positive women during the late antiretroviral era. Risk factors as well as outcomes after treatment of cancerous or precancerous lesions were examined. This is a longitudinal retrospective review of cervical Pap tests performed on HIV-infected women with an intact cervix between 2004 and 2011. Subjects needed over two Pap tests for at least 2 years of follow-up. Progression was defined as those who developed a squamous intraepithelial lesion (SIL), atypical glandular cells (AGC), had low-grade SIL (LSIL) followed by atypical squamous cells-cannot exclude high-grade SIL (ASC-H) or high-grade SIL (HSIL), or cancer. Regression was defined as an initial SIL with two or more subsequent normal Pap tests. Persistence was defined as having an SIL without progression or regression. High-risk human papillomavirus (HPV) testing started in 2006 on atypical squamous cells of undetermined significance (ASCUS) Pap tests. AGC at enrollment were excluded from progression analysis. Of 1,445 screened, 383 patients had over two Pap tests for a 2-year period. Of those, 309 had an intact cervix. The median age was 40 years and CD4 + cell count was 277 cells/mL. Four had AGC at enrollment. A quarter had persistently normal Pap tests, 64 (31%) regressed, and 50 (24%) progressed. Four developed cancer. The only risk factor associated with progression was CD4 count. In those with treated lesions, 24 (59%) had negative Pap tests at the end of follow-up. More studies are needed to evaluate follow-up strategies of LSIL patients, potentially combined with HPV testing. Guidelines for HIV-seropositive women who are in care, have improved CD4, and have persistently negative Pap tests could likely lengthen the followup interval.

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mentioning

confidence: 99%

Progression and Regression of Cervical Pap Test Lesions in an Urban AIDS Clinic in the Combined Antiretroviral Therapy Era: A Longitudinal, Retrospective Study

Lofgren

Tadros

Herring-Bailey

et al. 2015

AIDS Research and Human Retroviruses

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“…For example, the 3-year cumulative risk of developing cervical precancer given presence of an infection with HPV-16 or -18 is nearly 10-fold higher compared to the other high-risk HPV types [16]. Furthermore, individuals with a weakened immune system due to an HIV-infection have been reported to be at an increased risk of developing cervical precancer and cancer [17,18].…”

Section: Hpv and Cervical Carcinogenesismentioning

confidence: 99%

Using novel biomarkers to triage young adult women with minor cervical lesions: a cost‐effectiveness analysis

Pedersen

Sørbye

et al. 2016

BJOG

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Objective To evaluate the short‐term consequences and cost‐effectiveness associated with the use of novel biomarkers to triage young adult women with minor cervical cytological lesions. Design Model‐based economic evaluation using primary epidemiological data from Norway, supplemented with data from European and American clinical trials. Setting Organised cervical cancer screening in Norway. Population Women aged 25–33 years with minor cervical cytological lesions detected at their primary screening test. Methods We expanded an existing simulation model to compare 12 triage strategies involving alternative biomarkers (i.e. reflex human papillomavirus (HPV) DNA/mRNA testing, genotyping, and dual staining) with the current Norwegian triage guidelines. Main outcome measures The number of high‐grade precancers detected and resource use (e.g. monetary costs and colposcopy referrals) for a single screening round (3 years) for each triage strategy. Cost‐efficiency, defined as the additional cost per additional precancer detected of each strategy compared with the next most costly strategy. Results Five strategies were identified as cost‐efficient, and are projected to increase the precancer detection rate between 18 and 57%, compared with current guidelines; however, the strategies did not uniformly require additional resources. Strategies involving HPV mRNA testing required fewer resources, whereas HPV DNA‐based strategies detected >50% more precancers, but were more costly and required twice as many colposcopy referrals compared with the current guidelines. Conclusion Strategies involving biomarkers to triage younger women with minor cervical cytological lesions have the potential to detect additional precancers, yet the optimal strategy depends on the resources available as well as decision‐makers' and women's acceptance of additional screening procedures. Tweetable abstract Women with minor cervical lesions may be triaged more accurately and effectively using novel biomarkers.

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“…Incidentally, Nigeria ranked the second in the world on the burden of HIV, behind South Africa 7 . The high burden of HIV in Nigeria may be a contributing factor to the growing incidence of cervical cancer, particularly in the younger age group since HIV-mediated immune-suppression has been shown to increase the prevalence of premalignant lesions of the cervix, and the hazard of progression from premalignant to invasive cervical cancer stages is equally higher in an HIV infected population 3,8,9 . Although the natural history and the etiologic agents for cervical cancer are wellknown 10 and the anatomical structure and location of the cervix lends itself for effective screening, detection and treatment of pre-cancer stages, this entirely preventable cancer continues to inflict pain, suffering and death among women in Nigeria.…”

Section: Societal Investment and Cervical Cancer Outcomesmentioning

confidence: 99%

The Need for Societal Investment to Improve Cervical Cancer Outcomes in Nigeria: A commentary

Musa

2017

Afr J Reprod Health

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Although cervical cancer is a preventable cancer with a well-known natural history, it remains a huge burden in developing countries of sub-Saharan Africa where organized cervical cancer screening services are lacking. Developed countries that have invested on providing organized screening programs have made substantial progress in reducing both incidence and mortality due to cervical cancer. Implementing evidence-based interventions such as human papillomavirus (HPV) vaccination of young girls, early detection and treatment of premalignant conditions of the cervix through conventional Pap cytology, HPV screening or visual aided inspection with acetic acid could significantly reduce incidence of new cases at population level. Societal investment for such preventive services and provision of effective treatment for those diagnosed at early stages will yield economic benefits in reducing premature deaths of women at the prime of their productive lives. From a societal perspective, this should be a priority area for national investment towards the achievement of sustainable development in Nigeria and similar settings in Africa. (Afr J Reprod Health 2017; 21[4]: 17-23).Keywords: Cancer prevention, treatment, society, cervical cancer RésuméBien que le cancer du col de l'utérus soit un cancer évitable avec une histoire naturelle bien connue, il reste un lourd fardeau dans les pays en développement d'Afrique subsaharienne où les services organisés de dépistage du cancer du col de l'utérus font défaut. Les pays développés qui ont investi dans la mise en place de programmes de dépistage organisés ont fait des progrès substantiels dans la réduction de l'incidence et de la mortalité dues au cancer du col de l'utérus. La mise en oeuvre d'interventions fondées sur des données probantes comme la vaccination des jeunes filles contre le papillomavirus humain (VPH), la détection précoce et le traitement des pathologies précancéreuses du col utérin par la cytologie des frottis vaginaux conventionnelle, le dépistage du VPH ou l'inspection visuelle assistée par l'acide acétique pourraient réduire de manière significative la fréquence des nouveaux cas au niveau de la population. L'investissement sociétal pour de tels services préventifs et la fourniture d'un traitement efficace aux personnes diagnostiquées à un stade précoce produiront des bénéfices économiques en réduisant les décès prématurés des femmes quand elles sont dans la fleur de leur vie productive. D'un point de vue sociétal, cela devrait constituer un domaine prioritaire pour l'investissement national en vue de la réalisation du développement durable au Nigeria et dans des contextes similaires en Afrique. (Afr J Reprod Health 2017; 21[4]: 17-23).

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Incidence and progression of cervical lesions in women with HIV: a systematic global review

Cited by 144 publications

References 47 publications

Progression and Regression of Cervical Pap Test Lesions in an Urban AIDS Clinic in the Combined Antiretroviral Therapy Era: A Longitudinal, Retrospective Study

Progression and Regression of Cervical Pap Test Lesions in an Urban AIDS Clinic in the Combined Antiretroviral Therapy Era: A Longitudinal, Retrospective Study

Using novel biomarkers to triage young adult women with minor cervical lesions: a cost‐effectiveness analysis

The Need for Societal Investment to Improve Cervical Cancer Outcomes in Nigeria: A commentary

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