Screening and Treating Cervical Cancer in HIV-Positive Women in Cambodia

Raguenaud, Marie-Eve; Isaakidis, Petros; Ping, Chutema; Reid, Tony

doi:10.1097/qai.0b013e3181add6ac

Cited by 5 publications

(6 citation statements)

References 14 publications

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“…This might be a result of high sensitivity and overdiagnosis, and hence, overuse of VIA/VILI screening in the detection of cervical precancerous lesions. 16,21,22 The same effect was also seen in a study performed by Raguenaud et al 23 in Cambodia in HIV-positive women screened initially by VIA and later by cytology.…”

Section: Discussionsupporting

confidence: 76%

“…32 The longer survival of HIV-infected patients related to HAART may have a proportionally greater impact on the risk of HPV-related cancers than the partial reversal of immunosuppression that occurs with HAART. 23,30,33 The strength of our investigation was that we performed a large, comparative, retrospective study in Tanzania. The weakness was that we had to rely on information documented by others, such as the biopsy diagnosis in the case of referred patients.…”

Section: Discussionmentioning

confidence: 99%

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Influence of HIV/AIDS on Cervical Cancer: A Retrospective Study From Tanzania

Chambuso

Shadrack

Lidenge

et al. 2017

JGO

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PurposeCervical cancer is the leading cause of cancer-related morbidity and mortality in women in Tanzania. Any impact of the HIV/AIDS epidemic on cervical precancerous lesions and invasive cervical cancer has a significant implication, as for any public health concern, especially in an area such as the Morogoro region in Tanzania, which has one of the highest rates of cervical cancer in the world.MethodsA comparative retrospective study was performed of 536 women screened for cervical cancer by visual inspection methods at the Morogoro Regional Referral Hospital over a period of 3 years; the women were grouped according to their HIV status. The odds ratios (OR) with 95% CIs were estimated using χ2 test and multivariate analysis. The test statistics were evaluated with a significance level of P < .05.ResultsThe prevalence of precancerous lesions was 71.8% in HIV-positive women and 27.3% in HIV-seronegative women. Furthermore, the prevalence of extensive or large precancerous lesions was 40.5% in HIV-positive women and 13.5% in HIV-seronegative women. The prevalence of invasive cervical cancer was 8% in HIV-seronegative women and 11% in HIV-positive women. The risk factors for the cervical lesions were HIV-positive status (OR, 6.8; 95% CI, 4.2 to 11.2; P < .001) and being older than 30 years of age (OR, 11.99; 95% CI, 6.86 to 21.21; P < .001).ConclusionHIV/AIDS has a highly statistically significant association with (P < .001) and a great influence on the development of cervical precancerous lesions in HIV-positive women; however, its direct involvement in the progression to invasive cervical cancer, especially in this era of highly active antiretroviral therapy, is questionable.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Influence of HIV/AIDS on Cervical Cancer: A Retrospective Study From Tanzania

Chambuso

Shadrack

Lidenge

et al. 2017

JGO

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“…The detection frequencies for Low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) were far higher than what has been reported by this study. [30] In addition, studies in Cambodia (25.0%), [31] the Bahamas (44.0%) [32] and China (8.4%) [33] , among women attending HIV clinics also report an elevated prevalence of HSIL/LSIL than has been reported by this study. [31,33]…”

Section: Discussionsupporting

confidence: 61%

Prevalence of cervical cancer and pre-cancerous lesions among unscreened Women in Kumasi, Ghana

Donkoh

Agyemang-Yeboah

Asmah³

et al. 2019

Medicine

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Ghana does not have a universal population-based cervical cancer screening program and there is very limited information about the distribution of cervical epithelial cell lesions. This study provides evidence that a moderately high prevalence of cervical cancer and precancerous lesions exists among unscreened women in Kumasi. The prevalence of cervical epithelial cell abnormalities among a cross-section of women attending cervical cancer screening for the first time in a suburb of Ghana from 2011 to 2014 was studied. Cervical smears were prepared and examined independently by 2 cytotechnologists and confirmed by a pathologist. Cervical lesions were classified according to the Bethesda System for cervical cytology 2001. Out of the 592 women for whom a Pap smear was available for evaluation, 555 (93.8%) were negative for intraepithelial lesion or malignancy. Eight women (1.4%) showed atypical squamous cells of undetermined significance (ASCUS), 9 (1.4%) low-grade squamous intraepithelial lesions, and 2 (0.3%) high-grade squamous intraepithelial lesions. A total of 15 (2.5%) smears were unsatisfactory for cervical cytology. Additionally, 3 women (0.5%) had squamous cell carcinoma, giving an overall rate of 3.7% for epithelial cell abnormalities. Cervical cancer and precursor epithelial cell abnormalities are common among women in Kumasi for a disease that can be prevented by early detection through routine screening and management. This study provides adequate background data to recommend the implementation of cervical cancer screening in all eligible women in Ghana.

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“…Moreover, in studies among HIV-infected women in Sao Paolo, Rio De Janeiro, and Belo Horizonte, Brazil, 13%, 24%, and 24% had a diagnosis of squamous intraepithelial lesions, respectively 11–13. In studies in Cambodia, Thailand, and People’s Republic of China, the prevalence of HSIL/LSIL among women attending HIV clinics was 17%, 16%, and 8%, respectively 8,14,15. Studies conducted in Zambia and Kenya reported higher prevalences, 33% and 27%, respectively, among HIV-infected women16,17 Finally, in our study, and bearing in mind the available published evidence, we report an intermediate HPV prevalence among HIV-infected women.…”

Section: Discussionmentioning

confidence: 99%

“…Implementation of a cytology-based screening strategy in rural or resource-limited settings may be challenging. In previous MSF experience in Cambodia, “screening for cervical cancer using the conventional Pap test proved just as difficult for HIV-positive women, already enrolled in care, as for women of the general population.”8…”

Section: Discussionmentioning

confidence: 99%

HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mumbai, India: 12-month follow-up

Isaakidis¹,

Pimple²,

Varghese³

et al. 2013

IJWH

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BackgroundHIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.MethodsFrom May 2010 to October 2010, Médecins Sans Frontières and Tata Memorial Hospital Mumbai offered routine annual Pap smears and HPV DNA testing of women attending an antiretroviral therapy (ART) clinic and a 12-month follow-up. Women with abnormal test results were offered cervical biopsy and treatment, including treatment for sexually transmitted infections (STIs).ResultsNinety-five women were screened. Median age was 38 years (IQR: 33–41); median nadir CD4-count 143 cells/μL (IQR: 79–270); and median time on ART 23 months (IQR:10–41). HPV DNA was detected in 30/94 women (32%), and 18/94 (19%) showed either low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL) on Pap smear. Overall, >50% had cervical inflammatory reactions including STIs. Of the 43 women with a cervical biopsy, eight (8.4%) had CIN-1, five (5.3%) CIN-2, and two (2.1%) carcinoma in situ. All but one had HPV DNA detected (risk ratio: 11, 95% confidence interval: 3.3–34). By October 2011, 56 women had completed the 12-month follow-up and had been rescreened. No new cases of HPV infection/LSIL/HSIL were detected.ConclusionThe high prevalence of HPV infection, STIs, and cervical lesions among women attending an ART clinic demonstrates a need for routine screening. Simple, one-stop screening strategies are needed. The optimal screening interval, especially when resources are limited, needs to be determined.

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Screening and Treating Cervical Cancer in HIV-Positive Women in Cambodia

Cited by 5 publications

References 14 publications

Influence of HIV/AIDS on Cervical Cancer: A Retrospective Study From Tanzania

Influence of HIV/AIDS on Cervical Cancer: A Retrospective Study From Tanzania

Prevalence of cervical cancer and pre-cancerous lesions among unscreened Women in Kumasi, Ghana

HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mumbai, India: 12-month follow-up

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