Integrating Cervical Cancer Screening with HIV Care in Cameroon: Comparative Risk Analysis of Cervical Disease in HIV-Infected Women Receiving Antiretroviral Therapy to Women in the General Population

Abstract

BackgroundWhile the effect of highly active antiretroviral therapy (HAART) on natural history of cervical lesions remains controversial, resource limited countries need to understand the relevance of their own data to their settings. We compared the risk of cervical disease in HAART-experienced women with that in women in the general population of Cameroon.MethodsA retrospective cross sectional survey of women aged 35 years and above, attending a voluntary screening campaign for cervical cancer at the Nkongsamba Regional Hospital in Cameroon between February and May 2014. Squamous intraepithelial lesions (SIL) were determined by Pap smear. Multiple logistic regression was used to compare the odds of SIL in women on HAART to women from the community with unknown HIV status.ResultsIncluded were 302 women of whom 131(43.4%) were HIV-infected and receiving HAART on the site while 171 (56.6%) were women from the community. Cervical disease was observed in 51(16.9%) persons of whom 15 (11.5%) cases in the HAART group and 36 (21.1%) cases in the general group (p = 0.027). After controlling for age and other covariates, women in the HAART group had a 67% reduction in the odds of cervical lesions compared with the community group [adjusted odd ratio (aOR) = 0.33, 95%CI: 0.15–0.73, p = 0.006).ConclusionHIV-infected women receiving HAART have a lower risk of cancer than women in the general population. This finding may not be attributed to HAART alone but to all the health benefits derived from receiving a comprehensive HIV care.

Predictors of Locally Advanced Disease at Presentation and Clinical Outcomes Among Cervical Cancer Patients Admitted at a Tertiary Hospital in Botswana

“…Human immunodeficiency virus care clinics similarly remain significant gateways for screening and early cervical cancer diagnosis, hence the need to scale up integration of cervical cancer screening services into routine HIV/AIDS care. 19 History of cervical cancer screening was low at 38.7% (57/149), similar to findings by Ibekwe et al, 22 who reported 39% of eligible women having ever undergone screening in a general Mahalapye outpatient clinic in a rural setting in Botswana. Our finding, however, was much lower than Mingo and colleagues' 23 report of 72% among attendees of national referral hospital HIV clinic, a more urban setting.…”

“…18 Although 94% of our patients were already on HAART, this was not associated with earlier stage of disease at presentation. Although the role of HAART on progression of cervical cancer remains controversial, Bekolo et al 19 report a 67% reduction in odds of developing cervical cancer among women on HAART compared with those who were not on HAART. A significant proportion of our patients (28.9%) were diagnosed in their prime before the age of 40 years.…”

Associations between highly active antiretroviral therapy and the presence of HPV, premalignant and malignant cervical lesions in sub-Saharan Africa, a systematic review: current evidence and directions for future research

“…Bekolo et al (Cameroon, 2016) 35 also reported a decreased risk of cervical lesions among HAART receivers. After controlling for age and other covariates, women in the HAART group had a 67% reduction in the odds of cervical lesions compared with the community group (adjusted OR=0.33; 95% CI 0.15 to 0.73; p=0.006).…”

A review of screening strategies for cervical cancer in human immunodeficiency virus-positive women in sub-Saharan Africa

“… 11 – 13 Furthermore, evidence coming from studies conducted both in industrialized and developing countries has shown that the risk of developing cervical premalignant lesions increases as the CD4 count lowers. 14 , 15 This association could be more relevant in sub-Saharan Africa, where access to highly active antiretroviral therapy (HAART) and subsequent retention in care are still real challenges. 16 , 17 …”