Prospective One Year Follow Up of HIV Infected Women Screened for Cervical Cancer Using Visual Inspection with Acetic Acid, Cytology and Human Papillomavirus Testing in Johannesburg South Africa

Background

Cervical cancer is the most common cancer in Sub-Saharan Africa. There are little of HIV-infected women one-year after screening using visual inspection with acetic acid (VIA), HPV or cytology in sub-Saharan Africa.

Methods

HIV-infected women in Johannesburg South Africa were screened one year later by Pap smear, VIA and human papillomavirus (HPV) testing. Women qualified for the 12 month follow-up visit if they had a negative or cervical intra-epithelial neoplasia (CIN) 1 results at the baseline visit. Modified Poisson regression was used to analyse associations between patient baseline characteristics and progression.

Results

A total of 688 of 1,202 enrolled at baseline study who were CIN-2+ negative and qualified for a 12 month follow-up visit. Progression to CIN-2+ was higher in women with positive VIA results (12.6%; 24/191) than those VIA-negative (4.4%; 19/432). HPV-positive women at baseline were more likely to progress to CIN-2+ (12.3%; 36/293) than those HPV-negative (2.1%; 7/329). Cytology-positive women at baseline were more likely to progress to CIN-2+ (9.6%; 37/384) than cytology-negative women (2.5%; 6/237). Approximately 10% (10.4%; 39/376) of women with CIN 1 at baseline progressed to CIN 2+. Women who were VIA or HPV positive at baseline were more likely to progress aIRR 1.85, CI 95% (1.46 to 2.36), aIRR 1.41 CI 95% (1.14 to 1.75) respectively.

Conclusion

Progression to CIN-2+ in HIV-infected women is significant when measured by baseline positive VIA, HPV or Pap and yearly screening by any method should be considered in this population if possible.

Below:  Consort diagram of participant follow-up one year later

Full article at:   http://goo.gl/vMOeT8

By:  

Cynthia Firnhaber, Avril Swarts

Clinical HIV Research Unit, Faculty of Health Sciences, Department of Internal Medicine, University Witwatersrand, Johannesburg, South Africa

Cynthia Firnhaber, Bridgette Goeieman, Mark Faesen, Simon Levin, Sophie Williams, Sibongile Rameotshela, Kate Schnippel

Right to Care, Johannesburg, South Africa

Simon Levin

Department of OB/GYN, Coronation Hospital, University of Witwatersrand, Johannesburg, South Africa

Pam Michelow

Cytology Unit, Department of Anatomical Pathology, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa

Pam Michelow, Tanvier Omar

National Health Laboratory Service, Johannesburg, South Africa

Anna-Lise Williamson

Institute of Infectious Disease and Division of Medical Virology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa

Anna-Lise Williamson, Bruce Allan

National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa

Jennifer S. Smith

Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America

Jennifer S. Smith

Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America

  

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