Increased Risk of High‐Grade Cervical Squamous Intraepithelial Lesions and Invasive Cervical Cancer among African Women with Human Immunodeficiency Virus Type 1 and 2 Infections

Hawes, Stephen E.; Critchlow, Cathy W.; Niang, Mame Awa Faye; Diouf, Mame Boucar; Diop, Aissatou; Touré, Papa Souleymane; Kasse, A. A.; Dembélé, Birama; Sow, Papa Salif; Coll-Seck, Awa Marie; Kuypers, Jane; Kiviat, Nancy B.

doi:10.1086/376996

Cited by 160 publications

(144 citation statements)

References 65 publications

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“…The significant statistical difference between the degree of immunosupression (by CD4+ T-lymphocyte cell counts) and the degree of cervical SIL shows that the more the immunity is suppressed the higher the likelihood of having high grade cervical SIL. The results are consistent with those reported in other studies (Hawes et al, 2003;Parham et al, 2006).…”

Section: Discussionsupporting

confidence: 94%

Prevalence and severity of cervical squamous intraepithelial lesion in a tertiary hospital in northern Tanzania

Obure

Olola²,

Swai³

et al. 2010

Tanzania J Hlth Res

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Cervical cancer is the second most common cancer in women worldwide and the leading cause of cancer deaths in Tanzanian women. Prevention of cervical cancer relies on the detection and treatment of Squamous Intraepithelial Lesion (SIL), a premalignant disease stage. Worldwide there are overwhelming reports associating SIL and HIV infection, however in Tanzania such reports are limited. A cross-sectional hospital-based descriptive study was conducted to determine the prevalence and severity of SIL in 234 HIV seropositive and seronegative women aged 18-68 years old at Kilimanjaro Christian Medical Centre in northern Tanzania. A structured questionnaire was used to collect sociodemographic data. In addition, blood was collected for rapid HIV antibody testing and CD4+ T-lymphocyte counts to associate with prevalence and severity of SIL from the cervical smear collections. A total of 214 subjects had smear results regarded as valid for interpretation, of which 46.3% were HIV seropositive. Overall rate of SIL was 17%. Proportion of SIL among HIV seropositive subjects was 32% versus 4% in seronegative subjects (OR=13.3, 95% CI=4.2-46.4). Low CD4+ Tlymphocyte cell count was associated with higher prevalence of SIL (P=0.001). The relationship between CD4+ T-lymphocyte cell counts and the severity of cervical SIL was significant (P=0.007). Marital status and number of lifetime sex partners were risk factors significantly associated with SIL (P=0.004 and 0.005, respectively). SIL was not associated with age, education level, parity or age at sex debut. The prevalence and severity of cervical SIL was significantly associated with HIV infection and immunologic disease progression. These findings underscore the need for HIV screening among women with SIL, and the need for cervical cancer screening in HIV-infected women. Marital status and number of lifetime sex partners were significant risk factors associated with SIL. _______________________________________________________________________________________

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Section: Discussionsupporting

confidence: 94%

Prevalence and severity of cervical squamous intraepithelial lesion in a tertiary hospital in northern Tanzania

Obure

Olola²,

Swai³

et al. 2010

Tanzania J Hlth Res

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“…We also found that HIV-1 infection was independently associated with an increase in SIL among HPV-positive women and that HIV-1 represented an important risk factor for the presence of HSIL. These findings are in agreement with other African series (La Ruche et al, 1998;Chirenje et al, 2002;Hawes et al, 2003) and with many studies in industrialised countries (Sun et al, 1997;Ahdieh et al, 2001;Moscicki et al, 2004b;Strickler et al, 2005).…”

Section: Discussionsupporting

confidence: 93%

“…However, the relationships between HIV-1, HPV and squamous intraepithelial lesions (SIL) in sub-Saharan Africa are unclear. Some studies have found no association between HIV-1 and HPV (Mayaud et al, 2001), others found an association between HIV-1 and HPV, but no association between HIV-1 and SIL (De Vuyst et al, 2003), while others found a strong association between HIV-1, HR-HPV, high-grade SIL (HSIL), and cervical cancer (La Ruche et al, 1998;Chirenje et al, 2002;Hawes et al, 2003). Surprisingly, the relentless progression of the AIDS epidemic on the African continent has not been paralleled by increases in cervical cancer rates, in contrast with rates of other AIDS-linked cancers, such as Kaposi's sarcoma or non-Hodgkin's lymphomas (Parkin et al, 1999).…”

mentioning

confidence: 99%

Human papillomavirus genotype distribution and cervical squamous intraepithelial lesions among high-risk women with and without HIV-1 infection in Burkina Faso

et al. 2006

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Human papillomavirus (HPV) infection and cervical squamous intraepithelial lesions (SILs) were studied in 379 high-risk women. Human papillomavirus DNA was detected in 238 of 360 (66.1%) of the beta-globin-positive cervical samples, and 467 HPV isolates belonging to 35 types were identified. Multiple (2 -7 types) HPV infections were observed in 52.9% of HPV-infected women. The most prevalent HPV types were HPV-52 (14.7%), HPV-35 (9.4%), HPV-58 (9.4%), HPV-51 (8.6%), HPV-16 (7.8%), HPV-31 (7.5%), HPV-53 (6.7%), and HPV-18 (6.4%). Human immunodeficiency virus type 1 (HIV-1) seroprevalence was 36.0%. Human papillomavirus prevalence was significantly higher in HIV-1-infected women (87 vs 54%, prevalence ratio ( Cervical cancer is the most frequent cancer of women in developing countries, particularly in sub-Saharan Africa (Parkin et al, 1999), and it is now well established that genital infection with certain types of human papillomavirus (HPV) causes virtually all cases of cervical intraepithelial neoplasia (CIN) and invasive cervical cancer (ICC) (Walboomers et al, 1999). The HPV types that infect the genital tract have been subdivided into low-risk (LR) types, which are principally found in nonmalignant lesions such as genital warts, and high-risk (HR) types, which are associated with the development of CIN and ICC. Human papillomavirus types 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, and 89 are classified as LR types, whereas types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82 are classified as HR types. In addition, HPV types 26, 53, and 66 are considered as probably carcinogenic (Muñoz et al, 2003).Human papillomavirus prophylactic vaccines are now being developed and promising results have been obtained with recombinant L1 capsid protein virus-like particles (VLPs). However, the current HPV vaccines target the most prevalent high-risk HPV (HR-HPV) types worldwide, namely HPV-16 and HPV-18 (Koutsky et al, 2002;Ault et al, 2004;Brown et al, 2004;Harper et al, 2004). It has been shown that crossneutralisation induced by L1 VLPs represents less than 1% of the neutralising activity induced by the dominant conformational epitope , indicating that current HPV vaccines would be able to confer only type-specific immunity. Therefore, effectiveness of these vaccines on the prevention of cancer may be lower in populations highly affected by HR-HPV types other than HPV-16 and HPV-18. Thus, it is important to document the distribution of HPV genotypes in HPV-infected women and in women with cervical neoplasia in African countries in order to assess the potential effectiveness of a bivalent HPV-16/18 vaccine.There have been few detailed studies of HPV genotypes and their association with intraepithelial lesions or ICC in sub-Saharan Africa. Available data suggest, however, a higher prevalence and wider spectrum of oncogenic HPV types compared to studies conducted elsewhere (Castellsague et al, 2001;De Vuyst et al, 2003;Mayaud et al, 2003;Clifford et al, 2005;Wall et al, 2005). Furthermore, the high backgr...

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“…Hawes et al in Senegal found invasive cervical cancer in 0.3% of HIVnegative women, compared with 1.9% in HIV-1 positive women (OR 6.7, 95% CI 2.1-21.7), 4.5% in HIV-2 positive women (OR 16.0, 95% CI 3.8-67.7) and 6.9% in dually-infected women (OR, 37.2; 95% CI 6.6-210). 35 A recently published study from Tanzania showed prevalence of HIV-1 was much higher among the cervical cancer patients (21.0%) than among the controls (11.6%). HIV-1 was a significant risk factor for cancer of the cervix (OR=2.9, 95% CI=1.4-5.9).…”

Section: Biological Factorsmentioning

confidence: 95%

Cervical cancer: the sub-Saharan African perspective

Anorlu¹

2008

Reproductive Health Matters

259

239

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Cervical cancer is the second most common cancer in women worldwide and the leading cause of cancer deaths in developing countries. While incidence and mortality rates of cervical cancer have fallen significantly in developed countries, 83% of all new cases that occur annually and 85% of all deaths from the disease occur in developing countries. Cervical cancer is the most common cancer among women in sub-Saharan Africa. The incidence is on the increase in some countries. Knowledge and awareness of this disease on the continent are very poor and mortality still very high. Facilities for the prevention and treatment of cervical cancer are still very inadequate in many countries in the region. Governments in sub-Saharan Africa must recognise cervical cancer as a major public health concern and allocate appropriate resources for its prevention and treatment, and for research. Indeed, cervical cancer in this region must be accorded the same priority as HIV, malaria, tuberculosis and childhood immunisations.

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Increased Risk of High‐Grade Cervical Squamous Intraepithelial Lesions and Invasive Cervical Cancer among African Women with Human Immunodeficiency Virus Type 1 and 2 Infections

Cited by 160 publications

References 65 publications

Prevalence and severity of cervical squamous intraepithelial lesion in a tertiary hospital in northern Tanzania

Prevalence and severity of cervical squamous intraepithelial lesion in a tertiary hospital in northern Tanzania

Human papillomavirus genotype distribution and cervical squamous intraepithelial lesions among high-risk women with and without HIV-1 infection in Burkina Faso

Cervical cancer: the sub-Saharan African perspective

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