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Bi D, Wei S, Luo X, Luo X, Tang X. Management for persistent HPV infection and cervical lesions among women infected with HIV: a retrospective observational cohort study. Virol J 2024; 21:133. [PMID: 38844960 PMCID: PMC11157722 DOI: 10.1186/s12985-024-02405-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Early diagnosis and treatment of HPV persistent infection and cervical intraepithelial neoplasia, which have yet to be thoroughly characterized in Guangxi, Southwestern China, are the key preventative measures for the development of cervical cancer in women, particularly in HIV-infected women. METHODS A retrospective study of 181 patients with HPV infection or cervical intraepithelial neoplasia who received surgical excision of lesions and were prospectively enrolled at the Fourth People's Hospital of Nanning between January 2018 and February 2023 was performed. HPV-infected patients were divided into two subgroups: HIV-infected and HIV/HPV-coinfected patients and compare differences between these groups. RESULTS HPV16, 18, 52, and 58 were the most prevalent HPV genotypes. High-risk HPV was significantly co-infected with multiple genotypes (P = 0.0332). HIV-infected women were predisposed to HPV infection (P < 0.0001), and the development of cervical cancer at a young age (P = 0.0336) compared to HIV-uninfected women and the loop electrosurgical excision procedure (P = 0.0480) is preferred for the treatment. CONCLUSIONS HIV infection may increase HPV prevalence and lead to cervical cancer development at a young age. The loop electrosurgical excision procedure is an efficient evaluation and treatment strategy for HIV-infected women suffering from cervical intraepithelial neoplasia.
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Affiliation(s)
- Dewu Bi
- Department of Clinical Laboratory, The Fourth People's Hospital of Nanning, Nanning, Guangxi, China.
- Key Laboratory of Infectious Diseases, The Fourth People's Hospital of Nanning, Nanning, Guangxi, China.
- HIV/AIDS Clinical Treatment Center of Guangxi (Nanning), Nanning, Guangxi, China.
| | - Shuzhen Wei
- Department of Obstetrics and Gynecology, The Fourth People's Hospital of Nanning, Nanning, Guangxi, China
- HIV/AIDS Clinical Treatment Center of Guangxi (Nanning), Nanning, Guangxi, China
| | - Xiaolu Luo
- Department of Clinical Laboratory, The Fourth People's Hospital of Nanning, Nanning, Guangxi, China
- Key Laboratory of Infectious Diseases, The Fourth People's Hospital of Nanning, Nanning, Guangxi, China
- HIV/AIDS Clinical Treatment Center of Guangxi (Nanning), Nanning, Guangxi, China
| | - Xiaocheng Luo
- Department of Clinical Laboratory, The Fourth People's Hospital of Nanning, Nanning, Guangxi, China
- Key Laboratory of Infectious Diseases, The Fourth People's Hospital of Nanning, Nanning, Guangxi, China
- HIV/AIDS Clinical Treatment Center of Guangxi (Nanning), Nanning, Guangxi, China
| | - Xike Tang
- Department of Infectious Diseases, The Fourth People's Hospital of Nanning, Nanning, Guangxi, China.
- HIV/AIDS Clinical Treatment Center of Guangxi (Nanning), Nanning, Guangxi, China.
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SOSSO SAMUELMARTIN, TCHOUAKET MICHELCARLOSTOMMO, FOKAM JOSEPH, SIMO RACHELKAMGAING, SEMENGUE EZECHIELNGOUFACKJAGNI, SANDO ZACHARIE, TORIMIRO JUDITH, TIGA ALINE, LOBE ELISEELONG, AMBADA GEORGIA, NANGE ACHILLE, NKA ALEXDURAND, CHENWI COLLINS, ABBA AISSATOU, KA'E AUDECHRISTELLE, FAINGUEM NADINE, ZAM MARIEKRYSTELNNOMO, YAGAI BOUBA, BILLONG SERGECLOTAIRE, COLIZZI VITTORIO, NDJOLO ALEXIS. Human papillomavirus positivity and cervical lesions in relation to HIV infection: a comparative assessment in the Cameroonian female population. J Public Health Afr 2023; 14:2334. [PMID: 37942060 PMCID: PMC10628794 DOI: 10.4081/jphia.2023.2334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/16/2022] [Indexed: 11/10/2023] Open
Abstract
Cervical lesions, induced by high-risk oncogenic human papillomavirus (HR-HPV), in the context of HIV remains a global health challenge. We determined the effect of HR-HPV on the development of cervical lesions in women with and without HIV infection. A cross-sectional analytical study was conducted among 257 women living in Cameroon. HIV serology, HR-HPV genotyping and cervico-vaginal smear (CVS) were performed for all participants; among those declared HIV positive, plasma HIV viral load and CD4 count were measured. Statistical analyses were performed using Graph Pad version 6.0; P#x003C;0.05 was considered statistically significant. The mean age of the participants in our study was 37±6.5 years. According to HIV serology, 184 (71.59%) were HIV-positive vs. 73 (28.40%) HIV-negative. Among the HIV-positive women, the median CD4 count was 438 [IQR: 317-597] cells/mm3 and the median viremia was #x003C;40 [IQR: #x003C;40-2318] copies/ml. After successful genotyping, the prevalence of HR-HPV was 36.32% (73/201), with a significantly higher proportion in HIV-infected individuals (41.98% (55/131) vs. 25.71% (18/70); P=0.02; OR=2.1). The overall rate of cervical lesions was 23.34% (60/257), with a non-significantly higher proportion in HIV-infected participants (25.00% (46/184) vs. 19.17% (14/73); P=0.31). Relevantly, the presence of HR-HPV was significantly associated with cervical lesions (P#x003C;0.0001; OR=5.07), with a higher odds of cervical lesion in HIV-positive individuals (P#x003C;0.0001 and OR=5.67) compared to HIV-negative individuals (P=0.03 and OR=3.83). Although oncogenic HPV appears to be an independent factor in the development of cervical lesions, this study reveals higher odds of cervical lesions among HIV/HPV co-infection than in HPV infection alone.
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Affiliation(s)
- SAMUEL MARTIN SOSSO
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
| | - MICHEL CARLOS TOMMO TCHOUAKET
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | - RACHEL KAMGAING SIMO
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
| | - EZECHIEL NGOUFACK JAGNI SEMENGUE
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
- Yaoundé Gynaeco-Obstetrics and Pediatric Hospital, Yaoundé, Cameroon
- University of Rome ‘Tor Vergata’, Rome, Italy
| | - ZACHARIE SANDO
- University of Yaoundé I, Cameroon
- Gyneco-obstetrical and Paediatric Hospital of Yaoundé, Cameroon
| | - JUDITH TORIMIRO
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
- University of Yaoundé I, Cameroon
| | - ALINE TIGA
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
| | - ELISE ELONG LOBE
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
| | - GEORGIA AMBADA
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
| | - ACHILLE NANGE
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
| | - ALEX DURAND NKA
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
- University of Rome ‘Tor Vergata’, Rome, Italy
- Evangelical University of Bandjoun, Cameroon
| | - COLLINS CHENWI
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
- University of Yaoundé I, Cameroon
| | - AISSATOU ABBA
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
| | - AUDE CHRISTELLE KA'E
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
| | - NADINE FAINGUEM
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
- University of Rome ‘Tor Vergata’, Rome, Italy
- Evangelical University of Bandjoun, Cameroon
| | - MARIE KRYSTEL NNOMO ZAM
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
- University of Yaoundé I, Cameroon
| | - BOUBA YAGAI
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
- University of Rome ‘Tor Vergata’, Rome, Italy
| | - SERGE CLOTAIRE BILLONG
- University of Yaoundé I, Cameroon
- Central Technical Group, National AIDS Control Committee, Yaoundé, Cameroon
| | - VITTORIO COLIZZI
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
- University of Rome ‘Tor Vergata’, Rome, Italy
- Evangelical University of Bandjoun, Cameroon
| | - ALEXIS NDJOLO
- Chantal Biya International Reference Center for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
- University of Yaoundé I, Cameroon
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Tchouaket MCT, Ka’e AC, Semengue ENJ, Sosso SM, Simo RK, Yagai B, Nka AD, Chenwi CA, Abba A, Fainguem N, Perno CF, Colizzi V, Fokam J. Variability of High-Risk Human Papillomavirus and Associated Factors among Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. Pathogens 2023; 12:1032. [PMID: 37623992 PMCID: PMC10458438 DOI: 10.3390/pathogens12081032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) carries the highest burden of high-risk human papillomavirus (HR-HPV) in the world, driven by, and together with, HIV infection. This systematic review aimed to identify HR-HPV genotypes and their associated factors among women in SSA. METHODS A systematic review and meta-analysis of studies conducted in SSA on HR-HPV was conducted. Standard electronic databases were searched. R software version 3.6.0 was used for meta-analysis, with p < 0.05 considered statistically significant. RESULTS We included 28 articles with a total of 22,652 participants. The overall pooled prevalence of HR-HPV genotypes was 55.13%, albeit high heterogeneity between studies. The overall pooled prevalence of HR-HPV genotypes in HIV-positive individuals was 75.51%, compared to 52.97% in HIV-negatives (OR = 4.68 (0.71-30.76)). HPV 16 (18%), 35 (10.12%), 52 (9.98%), 18 (9.7%) and 45 (6.82%) genotypes were the most prevalent. Twelve studies identified the most frequently reported risk factors associated with HR-HPV, with HIV infection (66.66%), multiple sexual partners (41.66%) and young age (41.66%) being the most reported risk factors. CONCLUSIONS The combined prevalence of HR-HPV genotypes among women in general and HIV-infected women in particular remains high in SSA. The presence of several genotypes not covered by the vaccine is remarkable and suggests the need for revision of current vaccination policies to prevent HR-HPV infections.
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Affiliation(s)
- Michel Carlos Tommo Tchouaket
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon (S.M.S.); (R.K.S.); (B.Y.); (A.D.N.); (C.A.C.); (A.A.); (N.F.)
- School of Health Sciences, Catholic University of Central Africa, Yaoundé P.O. Box 1110, Cameroon
| | - Aude Christelle Ka’e
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon (S.M.S.); (R.K.S.); (B.Y.); (A.D.N.); (C.A.C.); (A.A.); (N.F.)
- Faculty of Sciences, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Ezechiel Ngoufack Jagni Semengue
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon (S.M.S.); (R.K.S.); (B.Y.); (A.D.N.); (C.A.C.); (A.A.); (N.F.)
- Faculty of Sciences, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Faculty of Sciences, Evangelical University of Bandjoun, Bandjoun P.O. Box 127, Cameroon;
| | - Samuel Martin Sosso
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon (S.M.S.); (R.K.S.); (B.Y.); (A.D.N.); (C.A.C.); (A.A.); (N.F.)
| | - Rachel Kamgaing Simo
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon (S.M.S.); (R.K.S.); (B.Y.); (A.D.N.); (C.A.C.); (A.A.); (N.F.)
| | - Bouba Yagai
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon (S.M.S.); (R.K.S.); (B.Y.); (A.D.N.); (C.A.C.); (A.A.); (N.F.)
- Faculty of Sciences, Evangelical University of Bandjoun, Bandjoun P.O. Box 127, Cameroon;
| | - Alex Durand Nka
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon (S.M.S.); (R.K.S.); (B.Y.); (A.D.N.); (C.A.C.); (A.A.); (N.F.)
- Faculty of Sciences, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Faculty of Sciences, Evangelical University of Bandjoun, Bandjoun P.O. Box 127, Cameroon;
| | - Collins Ambe Chenwi
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon (S.M.S.); (R.K.S.); (B.Y.); (A.D.N.); (C.A.C.); (A.A.); (N.F.)
- Faculty of Sciences, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Aissatou Abba
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon (S.M.S.); (R.K.S.); (B.Y.); (A.D.N.); (C.A.C.); (A.A.); (N.F.)
| | - Nadine Fainguem
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon (S.M.S.); (R.K.S.); (B.Y.); (A.D.N.); (C.A.C.); (A.A.); (N.F.)
- Faculty of Sciences, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Faculty of Sciences, Evangelical University of Bandjoun, Bandjoun P.O. Box 127, Cameroon;
| | | | - Vittorio Colizzi
- Faculty of Sciences, Evangelical University of Bandjoun, Bandjoun P.O. Box 127, Cameroon;
| | - Joseph Fokam
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé P.O. Box 3077, Cameroon (S.M.S.); (R.K.S.); (B.Y.); (A.D.N.); (C.A.C.); (A.A.); (N.F.)
- School of Health Sciences, Catholic University of Central Africa, Yaoundé P.O. Box 1110, Cameroon
- Faculty of Sciences, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Faculty of Sciences, Evangelical University of Bandjoun, Bandjoun P.O. Box 127, Cameroon;
- Faculty of Health Sciences, University of Buea, Buéa P.O. Box 63, Cameroon
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Sanchez-Covarrubias AP, Crane J, Montgomerie EK, Potter JE, Duthely LM, Bahadue F, Jeudin PP. Examining 5-Year Cervical Cytology Progression Among Minority Women Living With HIV and Baseline Negative Cytology. J Low Genit Tract Dis 2022; 26:304-309. [PMID: 36126202 PMCID: PMC9508966 DOI: 10.1097/lgt.0000000000000694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Women living with HIV (WLWH) have increased risk of human papillomavirus (HPV) infection, precancers, and invasive cervical cancers. This study aims to determine the rate of cervical cytologic progression and related factors in minority WLWH across 5 years. MATERIALS AND METHODS We used our HIV clinic database, complemented with a retrospective chart review to identify WLWH with a baseline negative cervical cytology between 2009 and 2012 and 5-year follow-up. Data included race/ethnicity, age, years living with HIV, AIDS status, viral load, history of smoking, drug use, and HPV status. Multivariate logistic regression tested progression of negative cytology to low-grade/high-grade squamous intraepithelial lesions (LGSIL/HGSIL). RESULTS Among 162 WLWH, 42% were African American, 30% non-Hispanic African Caribbean, and 26% Hispanic. At baseline, 21% had detectable viral load (>200 cp/mL), mean age was 44.8 (±11 years), and mean years living with HIV was 9.6 (±6.9). After 5 years, 19% of the cohort progressed to LGSIL/HGSIL. Human papillomavirus was detected consistently among women with cytologic changes (30% vs 7%, p < .01). Significant factors that predicted higher likelihood of progression to LGSIL/HGSIL were detection of HPV (adjusted odds ratios = 5.11 [1.31-19.93]; p = .02), and Centers for Disease Control and Prevention-defined AIDS status (adjusted odds ratios = 4.28 [1.04-17.63]; p = .04). Of the women who maintained negative cytology at 1 to 2 years (n = 102), 5 women (5%) progressed during the following 3 years before the recommended follow-up. CONCLUSIONS Human papillomavirus detection and AIDS status were significant factors predicting progression to LGSIL/HGSIL among minority WLWH. Providers screening WLWH for cervical intraepithelial neoplasia should carefully decide screening intervals for minority populations.
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Affiliation(s)
- Alex P. Sanchez-Covarrubias
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, FL
- Sylvester Comprehensive Cancer Center, Miami, FL
| | - Joshua Crane
- Georgetown University School of Medicine, Washington DC
| | | | - JoNell E. Potter
- Sylvester Comprehensive Cancer Center, Miami, FL
- Division of Research and Special Projects, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami, Miami, FL
| | - Lunthita M. Duthely
- Sylvester Comprehensive Cancer Center, Miami, FL
- Division of Research and Special Projects, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami, Miami, FL
| | - Felicia Bahadue
- Division of Research and Special Projects, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami, Miami, FL
| | - Patricia P. Jeudin
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, FL
- Sylvester Comprehensive Cancer Center, Miami, FL
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Rikhotso RR, Mitchell EM, Wilson DT, Doede A, Matume ND, Bessong PO. Prevalence and distribution of selected cervical human papillomavirus types in HIV infected and HIV uninfected women in South Africa, 1989-2021: A narrative review. S Afr J Infect Dis 2022; 37:363. [PMID: 35815224 PMCID: PMC9257898 DOI: 10.4102/sajid.v37i1.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Human papillomavirus infection, a causative agent of cervical cancer, is of great concern, more so in populations with high HIV prevalence, such as South Africa. Aim This review aimed to examine the prevalence and distribution of selected cervical human papillomavirus (HPV) types in HIV infected and HIV uninfected women in South Africa. Methods PubMed and Web of Science databases were searched using key words. For data integrity, data was assessed by two authors independently. The study inclusion criteria comprised records on cervical HPV, HPV genotyping and HPV type distribution among South African women. Statistical analysis was performed using Social Science Statistics. Results Sixty-nine articles met the inclusion criteria for analysis. Data on cervical HPV prevalence and type distribution was available only for five of the nine provinces of South Africa. Only 4/69 studies used sequencing as an approach to identify HPV types. In a general population, HPV type 16 was the most frequent (8.80%), followed by types 35 (4.86%), 18 (4.14%), 58 and 52 with the frequency of 3.65% and 3.62%, respectively. Furthermore, the least frequent type was HPV 70 (0.74%). Both HIV infected and HIV uninfected populations had a higher prevalence of high-risk human papillomavirus (hrHPV) types 16, 18 and 35 than other HPV types; while HPV types 6, 11 and 70 were the least frequent types from these populations. Lastly, HPV 16 was the most predominant type among women with normal (2.03%) and abnormal cervical cytology (6.60%). Conclusion Expanding on HPV genotyping will improve the knowledge in patterns of HPV type distribution in South Africa that will further help in decision making to improve current diagnostics, and future vaccine development and assessment.
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Affiliation(s)
- Rixongile R Rikhotso
- Department of Biochemistry and Microbiology, Faculty of Science, Engineering and Agriculture, University of Venda, Thohoyandou, South Africa
| | - Emma M Mitchell
- Department of Family, Community and Mental Health Systems, School of Nursing, University of Virginia, Charlottesville, United States of America
| | - Daniel T Wilson
- Claude Moore Health Sciences Library, School of Nursing, University of Virginia, Charlottesville, United States of America
| | - Aubrey Doede
- Department of Family Medicine and Public Health, University of California San Diego, California, United States of America
| | - Nontokozo D Matume
- HIV/AIDS & Global Health Research Programme, University of Venda, Thohoyandou, South Africa
| | - Pascal O Bessong
- HIV/AIDS & Global Health Research Programme, University of Venda, Thohoyandou, South Africa
- Center for Global Health Equity, School of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
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Isaguliants M, Nosik M, Karlsen A, Petrakova N, Enaeva M, Lebedeva N, Podchufarova D, Laga V, Gromov K, Nazarov A, Chowdhury S, Sinitsyn M, Sobkin A, Chistyakova N, Aleshina S, Grabarnik A, Palefsky JM. Prevalence and Risk Factors of Infection with High Risk Human Papilloma Viruses among HIV-Positive Women with Clinical Manifestations of Tuberculosis in a Middle-Income Country. Biomedicines 2021; 9:biomedicines9060683. [PMID: 34208764 PMCID: PMC8234035 DOI: 10.3390/biomedicines9060683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/22/2021] [Accepted: 05/27/2021] [Indexed: 12/19/2022] Open
Abstract
Women living with HIV-1 are at high risk of infection with human papillomavirus of high carcinogenic risk (HR HPVs). M. tuberculosis (TB) promotes HPV infection and increases the risk to develop HPV-associated cancer. Our knowledge of persisting HR HPVs genotypes, and of the factors promoting HR HPV infection in people living with HIV-1 with clinical TB manifestations is sparse. Here, we analyzed 58 women living with HIV-1 with clinical TB manifestations (WLWH with TB) followed up in specialized centers in Russia, a middle income country endemic for HIV-1 and TB, for the presence in cervical smears of DNA of twelve HR HPV genotypes. DNA encoding HPV16 E5, E6/E7 was sequenced. Sociodemographic data of patients was collected by questionnaire. All women were at C2-C3 stages of HIV-infection (by CDC). The majority were over 30 years old, had secondary education, were unemployed, had sexual partners, experienced 2–3 pregnancies and at least one abortion, and were smokers. The most prevalent was HPV16 detected in the cervical smears of 38% of study participants. Altogether 34.5% of study participants were positive for HR HPV types other than HPV16; however, but none of these types was seen in more than 7% of tested samples. Altogether, 20.7% of study participants were positive for several HR HPV types. Infections with HPVs other than HPV16 were common among WLWH with generalized TB receiving combined ART/TB-therapy, and associated with their ability to work, indirectly reflecting both their health and lifestyle. The overall prevalence of HR HPVs was associated with sexual activity of women reflected by the number of pregnancies, and of HPV 16, with young age; none was associated to CD4+-counts, route of HIV-infection, duration of life with HIV, forms of TB-infection, or duration of ART, characterizing the immune status. Thus, WLWH with TB—especially young—were predisposed to infection with HPV16, advancing it as a basis for a therapeutic HPV vaccine. Phylogenetic analysis of HPV16 E5, E6/E7 DNA revealed no common ancestry; sequences were similar to those of the European and American HPV16 strains, indicating that HPV vaccine for WLWH could be the same as HPV16 vaccines developed for the general population. Sociodemographic and health correlates of HR HPV prevalence in WLWH deserve further analysis to develop criteria/recommendations for prophylactic catch-up and therapeutic HPV vaccination of this highly susceptible and vulnerable population group.
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Affiliation(s)
- Maria Isaguliants
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden
- Institute of Microbiology and Virology, Riga Stradins University, LV-1007 Riga, Latvia
- N.F. Gamaleya National Research Center for Epidemiology and Microbiology, 123098 Moscow, Russia; (A.K.); (N.P.); (V.L.); (K.G.)
- Correspondence: or
| | - Marina Nosik
- I.I. Mechnikov Institute of Vaccine and Sera, 105064 Moscow, Russia;
| | - Anastasia Karlsen
- N.F. Gamaleya National Research Center for Epidemiology and Microbiology, 123098 Moscow, Russia; (A.K.); (N.P.); (V.L.); (K.G.)
- I.I. Mechnikov Institute of Vaccine and Sera, 105064 Moscow, Russia;
- Medical Academy for Continuous Professional Education, 125993 Moscow, Russia
| | - Natalia Petrakova
- N.F. Gamaleya National Research Center for Epidemiology and Microbiology, 123098 Moscow, Russia; (A.K.); (N.P.); (V.L.); (K.G.)
| | - Marina Enaeva
- Moscow Clinical Scientific Center Named after A.S. Loginov, 111123 Moscow, Russia;
| | - Natalia Lebedeva
- Moscow Regional Center for Prevention and Control of AIDS and Infectious Diseases, 129110 Moscow, Russia; (N.L.); (D.P.)
| | - Daria Podchufarova
- Moscow Regional Center for Prevention and Control of AIDS and Infectious Diseases, 129110 Moscow, Russia; (N.L.); (D.P.)
| | - Vita Laga
- N.F. Gamaleya National Research Center for Epidemiology and Microbiology, 123098 Moscow, Russia; (A.K.); (N.P.); (V.L.); (K.G.)
| | - Konstantin Gromov
- N.F. Gamaleya National Research Center for Epidemiology and Microbiology, 123098 Moscow, Russia; (A.K.); (N.P.); (V.L.); (K.G.)
| | | | - Sona Chowdhury
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA; (S.C.); (J.M.P.)
| | - Mikhail Sinitsyn
- Moscow Scientific and Clinical Center for TB Control, 107076 Moscow, Russia; (M.S.); (S.A.); (A.G.)
| | - Alexander Sobkin
- G.A. Zaharyan Moscow Tuberculosis Clinic, Department for Treatment of TB Patients with HIV Infection, 125466 Moscow, Russia; (A.S.); (N.C.)
| | - Natalya Chistyakova
- G.A. Zaharyan Moscow Tuberculosis Clinic, Department for Treatment of TB Patients with HIV Infection, 125466 Moscow, Russia; (A.S.); (N.C.)
| | - Svetlana Aleshina
- Moscow Scientific and Clinical Center for TB Control, 107076 Moscow, Russia; (M.S.); (S.A.); (A.G.)
| | - Alexei Grabarnik
- Moscow Scientific and Clinical Center for TB Control, 107076 Moscow, Russia; (M.S.); (S.A.); (A.G.)
| | - Joel M. Palefsky
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA; (S.C.); (J.M.P.)
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Incidence, Persistence, and Factors Associated With HPV Infection Among Male Adolescents With and Without Perinatally Acquired HIV Infection. J Acquir Immune Defic Syndr 2021; 85:553-560. [PMID: 32925357 DOI: 10.1097/qai.0000000000002499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infection with high-risk human papillomavirus (HR-HPV) has been shown to be more prevalent and persistent in female adolescents with HIV. However, data among male adolescents with perinatally acquired HIV (PHIV) are limited. SETTING We investigated the incidence and persistence of HR-HPV in anogenital compartments and associated factors among PHIV in comparison to HIV-uninfected (HU) male adolescents in Thailand. METHODS PHIV and HU males aged 12-24 years were enrolled. At baseline and 3 subsequent annual visits, specimens from the scrotum, penis, and anal area were obtained for HPV and other testing. RESULTS From June 2013 to October 2017, 49 PHIV and 47 HU male adolescents with a median age of 18 (interquartile range 17-20) years were enrolled. PHIV had higher incidence of any HR-HPV infection than HU adolescents {33.05 [95% confidence interval (CI): 20.82 to 52.46] vs. 15.73 [95% CI: 8.18 to 30.22] per 100 person-years, P = 0.04}. The persistence of any HR-HPV genotypes (detected at ≥2 annual visits) was not different by group (PHIV 27% vs. HU 23%, P = 0.75). Having ≥3 sex partners in past 6 months (adjusted prevalence ratio 2.39, 95% CI: 1.14 to 5.05; P = 0.02) and co-infection with other sexually transmitted infections (syphilis, chlamydia, and/or gonorrhea) were associated with persistent HR-HPV infection (adjusted prevalence ratio 6.21, 95% CI: 2.87 to 13.41; P < 0.001). CONCLUSIONS Thai PHIV male adolescents had a higher incidence of HR-HPV infection than those without HIV. Having multiple sex partners and co-infection with sexually transmitted infections was associated with persistent HR-HPV infection. These data demonstrate the need to prioritize PHIV male adolescents in routine and catch-up HPV vaccination programs.
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8
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Nandi A, Jain B, Adhikary T, Sadhukhan P. Human papilloma virus infection of uterine cervix and spectrum of cervical pathology in human immunodeficiency virus/AIDS. J Cancer Res Ther 2021; 17:1462-1467. [DOI: 10.4103/jcrt.jcrt_552_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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9
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Mandiriri AM, Pascoe MJ, Shamu T, Lowe S. Cervical human papillomavirus prevalence, risk factors and outcomes in a cohort of HIV-infected women in Harare, Zimbabwe. South Afr J HIV Med 2020; 21:1123. [PMID: 33240535 PMCID: PMC7670035 DOI: 10.4102/sajhivmed.v21i1.1123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/30/2020] [Indexed: 12/25/2022] Open
Abstract
Background Human papillomavirus (HPV) associated invasive cervical cancer (ICC) is common in Zimbabwe, disproportionately affecting women living with HIV (WLHIV). Understanding high-risk HPV (hrHPV) infection in relation to cervical disease is important for ICC prevention amongst WLHIV. Objectives To describe the prevalence of cervical hrHPV, type distribution, associated risk factors and ICC screening outcomes in an urban cohort of Zimbabwean women. Methods In this cohort study, WLHIV were tested for hrHPV infection using the Cepheid Xpert® HPV assay and followed up for incident cervical disease. Follow-up assessments were done by visual inspection with acetic acid (VIA). Descriptive statistics and logistic regression were used to describe hrHPV burden and association between hrHPV and potential risk factors. Incidence rates (IR) and rate ratios of cervical disease by hrHPV infection status were also calculated. Results Amongst 321 WLHIV recruited, hrHPV prevalence was 24.9% (n = 80). Fifty-two of these women (65%) were positive for hrHPV types other than 16 or 18/45. Younger age (22–29 years), early sexual debut (13–16 years) and antiretroviral therapy (ART) regimen (second-line ART) were independently associated with hrHPV positivity. Positive VIA IR ratio between hrHPV-positive and -negative women was 12.57 (95% confidence interval [CI]: 4.14–38.19). Only women with hrHPV infection had incident cervical disease (IR: 6.41/100 person-years, (95% CI: 3.33–12.32). There were no ICC cases by the end of the 2-year follow-up. Conclusion There was a high prevalence of hrHPV infection other than 16 and 18/45 in this cohort. Integrating HPV testing in cervical cancer screening programmes may increase screening intervals in hrHPV-negative women, reducing costs for programmes. We recommend further research into cross protectivity of the bivalent and quadrivalent HPV vaccines against these other hrHPV types.
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Affiliation(s)
- Ardele M Mandiriri
- Newlands Clinic, Harare, Zimbabwe.,Department of Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Tinei Shamu
- Newlands Clinic, Harare, Zimbabwe.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sara Lowe
- Newlands Clinic, Harare, Zimbabwe.,Department of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Bogale AL, Belay NB, Medhin G, Ali JH. Molecular epidemiology of human papillomavirus among HIV infected women in developing countries: systematic review and meta-analysis. Virol J 2020; 17:179. [PMID: 33198743 PMCID: PMC7670609 DOI: 10.1186/s12985-020-01448-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/05/2020] [Indexed: 12/31/2022] Open
Abstract
Background Although, there is a variable burden of human papillomavirus (HPV) in women infected with HIV in developing countries, there are few studies that attempted to surmise such variable evidences. This review aimed to estimate the pooled prevalence of HPV genotype distribution and risk factors contributing to HPV infection among women infected with HIV in low- and middle-income countries. Methods We conducted a systematic review and meta-analysis of studies conducted in developing countries and reported HPV prevalence. We searched electronic databases: PubMed/Medline, SCOPUS, ScienceDirect, Excerpta Medical Database from Elsevier, Web of science, Cumulative Index of Nursing and allied Health Sciences and Google scholar databases to retrieve primary studies published in English language till 11th August 2019. We used random-effects model to estimate the pooled prevalence of HPV genotypes, and funnel plot to assess publication bias. The registration number of this review study protocol is CRD42019123549. Results We included nineteen studies with a total of 8,175 participants in this review. The prevalence of HPV was extremely heterogeneous across the studies (χ2= 3782.80, p value < 0.001, I2 = 99.6%). The estimated pooled prevalence of all HPV genotypes was 63.0% (95% CI: 48.0–78.0) while the pooled prevalence of high risk and low risk HPV genotypes were 51.0% (95% CI: 38.0–63.0) and 28.0% (95% CI: 12.0–43.0), respectively. The pooled prevalence of HPV genotype 16 was 20%, while genotype 18 and 52 were 15% and 13%, respectively. Different risk factors reported for HPV infection and the frequently reported were low CD4 count below 200 cells/mm3 and high HIV viral load.
Conclusion The pooled prevalence of HPV among HIV infected women in low- and middle-income countries was considerable and the proportion of high risk HPV genotypes were high when compared with low risk genotypes. Therefore, it is essential for the HPV prevention program to prevent the double burden of HPV and HIV in women.
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Affiliation(s)
- Agajie Likie Bogale
- Ethiopian Public Health Institute, and Addis Ababa University, P.O. Box 1242, Addis Ababa, Ethiopia.
| | - Nega Berhe Belay
- Department of Tropical and Infectious Diseases, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Department of Tropical and Infectious Diseases, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia
| | - Jemal Haidar Ali
- School of Public Health, College of Health Sciences, Addis Ababa University, 1000, P.O. Box 27285, Addis Ababa, Ethiopia
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Ntuli ST, Maimela E, Skaal L, Mogale M, Lekota P. Abnormal cervical cytology amongst women infected with human immunodeficiency virus in Limpopo province, South Africa. Afr J Prim Health Care Fam Med 2020; 12:e1-e4. [PMID: 33054270 PMCID: PMC7564981 DOI: 10.4102/phcfm.v12i1.2215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/24/2020] [Accepted: 03/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background Cervical cancer remains the major public problem worldwide and the most common gynaecological malignancy in the developing world, particularly in sub-Saharan Africa. Aim To determine the prevalence of abnormal cervical cytology amongst women with and without human immunodeficiency virus (HIV) and examine the association between HIV and histological grading. Setting The study was conducted in Limpopo province, which is the northernmost province of South Africa. The province has five district municipalities with one tertiary, five regional and thirty four district hospitals. Methods We retrospectively reviewed cervical cancer cases in Limpopo province (LP) of South Africa, using data collected routinely by the National Health Laboratory Services (NHLS). The data on smears submitted for cytology between 2013 and 2015 were extracted from the Central Data Warehouse (CDW) database. Results A total of 84 466 women were screened for cervical cytology smears. Their mean age was 39.8 ± 13.6 years, with range from 15 to 113 years; 77.2% were in the age group 30 years and older and 19.6% had an abnormal cervical cytology result. Overall, 46.4% of the women screened for cervical cancer were HIV infected. A significantly higher proportion of HIV-positive women had abnormal cytology than HIV-negative women (31.8% vs. 9.2%). Conclusion The prevalence of abnormal cytology amongst HIV-positive women is relatively high, and the risk appears to be significantly greater in all age groups. This finding highlights the need to ascertain HIV status of all women presenting with cervical cancer.
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Affiliation(s)
- Samuel T Ntuli
- Department of Public Health, Faculty of Health Sciences, University of Limpopo, Sovenga, Soth Africa; and, Department of Statistics and Operations Research, Sefako Makgatho Health Science University, Ga-rankuwa.
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Cremer ML, Conzuelo-Rodriguez G, Cherniak W, Randall T. Ablative Therapies for Cervical Intraepithelial Neoplasia in Low-Resource Settings: Findings and Key Questions. J Glob Oncol 2019; 4:1-10. [PMID: 30372399 PMCID: PMC7010451 DOI: 10.1200/jgo.18.00093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Barriers to access for cervical precancer care in low-resource settings go beyond cost. Gas-based cryotherapy has emerged as the standard treatment in these areas, but there are barriers to this technology that have necessitated the development and implementation of affordable and portable alternatives. This review identifies knowledge gaps with regard to technologies primarily used in low-resource settings, including standard cryotherapy, nongas-based cryotherapy, and thermoablation. These gaps are addressed using evidence-based guidelines, patient and provider acceptability, long-term obstetric outcomes, and treatment of women with HIV infection. This review highlights the need for prospective studies that compare ablative methods, especially given the increasing use of thermoablation.
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Affiliation(s)
- Miriam L Cremer
- Miriam L. Cremer, Cleveland Clinic, Cleveland, OH; Gabriel Conzuelo-Rodriguez, Basic Health International, New York, NY; William Cherniak, Bridge to Health Medical and Dental, Toronto, Ontario, Canada; and Thomas Randall, Massachusetts General Hospital, Boston, MA
| | - Gabriel Conzuelo-Rodriguez
- Miriam L. Cremer, Cleveland Clinic, Cleveland, OH; Gabriel Conzuelo-Rodriguez, Basic Health International, New York, NY; William Cherniak, Bridge to Health Medical and Dental, Toronto, Ontario, Canada; and Thomas Randall, Massachusetts General Hospital, Boston, MA
| | - William Cherniak
- Miriam L. Cremer, Cleveland Clinic, Cleveland, OH; Gabriel Conzuelo-Rodriguez, Basic Health International, New York, NY; William Cherniak, Bridge to Health Medical and Dental, Toronto, Ontario, Canada; and Thomas Randall, Massachusetts General Hospital, Boston, MA
| | - Thomas Randall
- Miriam L. Cremer, Cleveland Clinic, Cleveland, OH; Gabriel Conzuelo-Rodriguez, Basic Health International, New York, NY; William Cherniak, Bridge to Health Medical and Dental, Toronto, Ontario, Canada; and Thomas Randall, Massachusetts General Hospital, Boston, MA
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Dreyer G, Maske C, Stander M. Clinical evaluation and budget impact analysis of cervical cancer screening using cobas 4800 HPV screening technology in the public sector of South Africa. PLoS One 2019; 14:e0221495. [PMID: 31509545 PMCID: PMC6738657 DOI: 10.1371/journal.pone.0221495] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/07/2019] [Indexed: 12/19/2022] Open
Abstract
Cytology remains the mainstay of cervical cancer screening in South Africa (SA), however false negative rates are 25-50%. In contrast, human papillomavirus (HPV) screening techniques have higher sensitivity for cervical cancer precursors. The cobas® 4800 HPV test detects pooled high-risk HPV types and individual genotypes HPV 16 and 18. Using a mathematical budget impact model, the study objective was to evaluate the clinical and budget impact of replacing primary liquid-based cytology (LBC) with primary HPV-based screening strategies. In SA, current LBC screening practice recommends one test every ten years, followed by large loop excision of the transformation zone (LLETZ) if indicated. HPV testing can be performed from an LBC sample, where no additional consultations nor samples are required. In the budget impact model, LBC screening for 2 cycles (one test every ten years) was compared to cobas® 4800 HPV test for 2 cycles (one test every 5 years). The model inputs were gathered from literature and primary data sources. Indicative prices for LBC and cobas® 4800 HPV test were R189 and R457, respectively. Model results indicate that best outcomes for detection of disease were seen using cobas® 4800 HPV test. Forty-eight percent of cervical cancer cases were detected compared to 28% using LBC, and 50% of cervical intraepithelial neoplasia (CIN) 2 and CIN3 cases, compared to 25% with LBC. The budget impact analysis predicted that the cost per detected case of CIN2 or higher would be R 56,835 and R46,980 for the cobas® 4800 HPV and LBC scenarios, respectively. This equates to an incremental cost per detected case of CIN2 or higher of R9 855. From this model we conclude that a primary HPV screening strategy will have a significant clinical impact on disease burden in South Africa.
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Affiliation(s)
- Greta Dreyer
- Faculty of Health Sciences, University of Pretoria, Gauteng, South Africa
- Department Obstetrics & Gynaecology, University of Pretoria, Gauteng, South Africa
- South African Society of Obstetrics and Gynaecological Oncology, Gauteng, South Africa
- South African Society of Gynaecologic Oncology, Gauteng, South Africa
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Menon S, Rossi R, Kariisa M, Acharya SD, Zdraveska N, Mahmood S, Callens S, Ndizeye Z. Relationship between Highly Active Antiretroviral Therapy (HAART) and human papillomavirus type 16 (HPV 16) infection among women in Sub-Saharan Africa and public health implications: A systematic review. PLoS One 2019; 14:e0213086. [PMID: 30856196 PMCID: PMC6411162 DOI: 10.1371/journal.pone.0213086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 02/14/2019] [Indexed: 12/17/2022] Open
Abstract
Invasive cervical cancer is the most prevalent cancer among women in Sub-Saharan Africa. In 2013, the World Health Organization (WHO) emitted recommendations to start Highly Active Antiretroviral Therapy (HAART) regardless of CD4 count. Although HAART has been shown to reduce the prevalence of high-risk human papillomavirus (HR-HPV) genotypes, it is unclear whether it confers a protective effect specifically for HPV 16. This review summarizes the existing evidence regarding the effect of HAART on HPV 16 infection, as this genotype may not be influenced by immunity level and explores its implications for Sub Saharan Africa. A comprehensive literature review was undertaken and quality assessment was carried out on the selected papers. Four cohort studies and three cross-sectional studies were identified for which the overall quality score assessment ranged from weak/moderate (Score of 1.8) to strong (Score of 3). The evidence yielded by our review was conflicting. Thus, the high heterogeneity between study populations and results did not allow us to draw any firm conclusions as to whether HAART has an impact on HPV 16 acquisition/prevalence. As only three studies were conducted in Africa, there are insufficient grounds for solid comparison between geographic regions. In light of inadequate data, HPV unvaccinated women on HAART should still receive more frequent follow-up.
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Affiliation(s)
- Sonia Menon
- International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan, Ghent, Belgium
- * E-mail:
| | - Rodolfo Rossi
- Primary Health Care Services, International Committee of the Red Cross, Geneva, Switzerland
| | - Mbabazi Kariisa
- March of Dimes Foundation, White Plains, New York, United States of America
| | | | - Natasha Zdraveska
- Faculty of Pharmacy, Department of Clinical Pharmacy, Saints Cyril and Methodius University (Alumni), Skopje, Republic of Macedonia
| | | | - Steven Callens
- Department of Internal Medicine & Infectious Diseases, University Hospital, Ghent, Belgium
| | - Zacharie Ndizeye
- Community Medicine Department, Faculty of Medicine, University of Burundi, Bujumbura, Burundi
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Vasnik GK, Jain G, Husainy FA, Bansal V. Correlation of Cervical Squamous Intraepithelial Lesions with Human Papillomavirus in Women Infected with the Human Immunodeficiency Virus. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-018-0251-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Davies G, Firnhaber C, Pantanowitz L, Michelow P. The relationship between menopausal women infected with the human immunodeficiency virus and cervical atrophy: A cytologic study. Diagn Cytopathol 2018; 47:302-306. [PMID: 30588777 DOI: 10.1002/dc.24092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 07/18/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND With the advent of combined antiretroviral therapy (cART), HIV positive women are expected to live longer. The effect of chronic HIV infection and cART on cervical epithelial maturation has not been well studied in postmenopausal woman. The objective of this study was to determine whether HIV positive postmenopausal women on cART show expected atrophic changes in cervical Pap tests. METHODS The maturation index (MI) was performed on routine cervical smears from HIV-infected, postmenopausal women attending an HIV clinic in a tertiary hospital in Johannesburg, over a 4-year period from January 2009 to December 2012. RESULTS In Pap smears of 111 patients on cART, 58 (52%) showed an unexpected predominantly mature squamous epithelial pattern whereas 53 (48%) were predominantly immature or atrophic (P = .0001). There was no significant statistical difference in maturation according to cART use. CONCLUSION HIV-infected, postmenopausal women in this study had reduced rates of cervical atrophy than expected, irrespective of cART use and CD4 count. Initiation of cART before menopause was associated with greater cervical epithelium maturation than those women who started cART after menopause. Additional, larger studies are required to confirm this novel finding and to investigate the reason for this phenomenon.
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Affiliation(s)
- Gillian Davies
- National Health Laboratory Services and Department of Anatomical Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Cynthia Firnhaber
- Department of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pamela Michelow
- National Health Laboratory Services and Department of Anatomical Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Rodrigues LLS, Morgado MG, Sahasrabuddhe VV, De Paula VS, Oliveira NS, Chavez-Juan E, Da Silva DM, Kast WM, Nicol AF, Pilotto JH. Cervico-vaginal self-collection in HIV-infected and uninfected women from Tapajós region, Amazon, Brazil: High acceptability, hrHPV diversity and risk factors. Gynecol Oncol 2018; 151:102-110. [PMID: 30087059 PMCID: PMC6151287 DOI: 10.1016/j.ygyno.2018.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/23/2018] [Accepted: 08/01/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE We evaluated acceptability of cervico-vaginal self-collection (CVSC) and prevalence of human papillomavirus (HPV) in Human immunodeficiency virus (HIV)-infected and HIV-uninfected women living in the Tapajós region, Amazon, Brazil. METHODS Cross-sectional study recruited 153 non-indigenous women (HIV-uninfected, n = 112 and HIV-infected, n = 41) who voluntarily sought assistance in health services. Peripheral blood for HIV screening and cervical scraping (CS) for HPV detection were collected. Women who accepted to perform CVSC received instructions and individual collection kits. Risk factors for high-risk HPV genotypes (hrHPV) were identified by uni- and multivariate analyses. RESULTS The overall acceptability of CVSC was 87%. Only HIV-infected women had cytological abnormalities (12.2%). Prevalence of any HPV and hrHPV infection was 42.9% and 47.9% for HIV-uninfected and 97.6% and 77.5% for HIV-infected women, respectively. There was significant agreement in the detection of HPV (88%, 0.76, 95% confidence interval [CI], 0.65-0.87) and hrHPV (79.7%, 0.56, 95% CI, 0.41-0.71) between self-collected and clinician-collected samples. The most prevalent hrHPV types were HPV16 and HPV18 in HIV-uninfected and HPV16, HPV51 and HPV59 in HIV-infected women. HIV-infected women with hrHPV infection had multiple hrHPV infections (p = 0.005) and lower CD4 count (p = 0.018). Risk factors for hrHPV infection included being HIV-infected and having five or more sexual partners. CONCLUSIONS CVSC had high acceptability and high prevalence of hrHPV types in women living in the Tapajós region, Amazon, Brazil.
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Affiliation(s)
- Luana L S Rodrigues
- Laboratório de AIDS e Imunologia Molecular, IOC-FIOCRUZ, Rio de Janeiro, Brazil; Instituto de Saúde Coletiva, Universidade Federal do Oeste do Pará, Santarém, Pará, Brazil.
| | - Mariza G Morgado
- Laboratório de AIDS e Imunologia Molecular, IOC-FIOCRUZ, Rio de Janeiro, Brazil.
| | | | | | - Nathália S Oliveira
- Programa de Pós-Graduação em Patologia, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Elena Chavez-Juan
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Diane M Da Silva
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA; Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - W Martin Kast
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA; Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Department of Molecular Microbiology and Immunology, University of Southern California, Los Angeles, CA, USA
| | - Alcina F Nicol
- Instituto Nacional de Infectologia Evandro Chagas, INI-FIOCRUZ, Rio de Janeiro, Brazil; Laboratório Interdisciplinar de Pesquisas Médicas, IOC-FIOCRUZ, Rio de Janeiro, Brazil
| | - José H Pilotto
- Laboratório de AIDS e Imunologia Molecular, IOC-FIOCRUZ, Rio de Janeiro, Brazil
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Mudini W, Palefsky JM, Hale MJ, Chirenje MZ, Makunike-Mutasa R, Mutisi F, Murahwa A, Mario A. Human Papillomavirus Genotypes in Invasive Cervical Carcinoma in HIV-Seropositive and HIV-Seronegative Women in Zimbabwe. J Acquir Immune Defic Syndr 2018; 79:e1-e6. [PMID: 29781877 PMCID: PMC6092204 DOI: 10.1097/qai.0000000000001754] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Invasive cervical carcinoma (ICC) accounts for 23% of all cancer-related deaths in Zimbabwean women. Trials for a national program of genotype-specific human papillomavirus (HPV) vaccines are underway to prevent cervical carcinoma, but the distribution of HPV types among women with ICC according to HIV status is unknown. METHODS To determine prevalence and distribution of high-risk HPV genotypes by HIV status in women with ICC, we performed a cross-sectional study on women referred for ICC testing at 4 urban referral hospitals in Zimbabwe from June 2014 to December 2015. Cervical biopsies were obtained for histology and HPV genotyping. HIV serology testing was performed. HPV testing was performed using MY09/MY11 polymerase chain reaction followed by typing using dot-blot hybridization. RESULTS Of 107 participants with histologically proven ICC, HIV prevalence was 49.5% (53/107). HIV-positive women tended to be younger (median age 44 years) than HIV-negative women (median age 59 years). HPV prevalence was 94% (101/107), ranging from 1 to 5 genotypes per participant. HPV 16 (81.5%), 18 (24%), 33 (13%), 35 (11%), 56 (9%), and 45 (7.4%) were the most prevalent genotypes among HIV-negative participants; HPV 16 (67.9%), 18 (43.4%), 56 (18.9%), 45 (15.1%), 33 (11.3%), and 58 (9.4%) were the most prevalent among HIV-positive participants. Eighty-three percent of women were infected with either HPV-16 or HPV-18. CONCLUSIONS Effective vaccination programs against HPV 16 and HPV 18 could prevent up to 83% of cases of cervical cancer in Zimbabwe. HIV may influence distribution of some HPV genotypes given the significant increase in prevalence of HPV 18 among HIV-positive participants.
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Affiliation(s)
- Washington Mudini
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Health, National Health Laboratory Service, Johannesburg, South Africa
| | - Joel M Palefsky
- Department of Medicine, University of California, San Francisco, CA
| | - Martin J Hale
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Health, National Health Laboratory Service, Johannesburg, South Africa
| | - Michael Z Chirenje
- University of Zimbabwe-University of California, San Francisco Collaborative Research Program, University of Zimbabwe, Harare, Zimbabwe
| | - Rudo Makunike-Mutasa
- Department of Histopathology, College of Health Sciences, University of Zimbabwe, Harare Zimbabwe
| | - Fiona Mutisi
- University of Zimbabwe-University of California, San Francisco Collaborative Research Program, University of Zimbabwe, Harare, Zimbabwe
| | - Alltalents Murahwa
- Department of Immunology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Altini Mario
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Noncommunicable diseases among HIV-infected persons in low-income and middle-income countries: a systematic review and meta-analysis. AIDS 2018; 32 Suppl 1:S5-S20. [PMID: 29952786 DOI: 10.1097/qad.0000000000001888] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To appropriately identify and treat noncommunicable diseases (NCDs) among persons living with HIV (PLHIV) in low-and-middle-income countries (LMICs), it is imperative to understand the burden of NCDs among PLHIV in LMICs and the current management of the diseases. DESIGN Systematic review and meta-analysis. METHODS We examined peer-reviewed literature published between 1 January 2010 and 31 December 2016 to assess currently available evidence regarding HIV and four selected NCDs (cardiovascular disease, cervical cancer, depression, and diabetes) in LMICs with a focus on sub-Saharan Africa. The databases, PubMed/MEDLINE, Cochrane Review, and Scopus, were searched to identify relevant literature. For conditions with adequate data available, pooled estimates for prevalence were generated using random fixed effects models. RESULTS Six thousand one hundred and forty-three abstracts were reviewed, 377 had potentially relevant prevalence data and 141 were included in the summary; 57 were selected for quantitative analysis. Pooled estimates for NCD prevalence were hypertension 21.2% (95% CI 16.3-27.1), hypercholesterolemia 22.2% (95% CI 14.7-32.1), elevated low-density lipoprotein 23.2% (95% CI 15.2-33.6), hypertriglyceridemia 27.2% (95% CI 20.7-34.8), low high-density lipoprotein 52.3% (95% CI 35.6-62.8), obesity 7.8% (95% CI 4.3-13.9), and depression 24.4% (95% CI 12.5-42.1). Invasive cervical cancer and diabetes prevalence were 1.3-1.7 and 1.3-18%, respectively. Few NCD-HIV integrated programs with screening and management approaches that are contextually appropriate for resource-limited settings exist. CONCLUSION Improved data collection and surveillance of NCDs among PLHIV in LMICs are necessary to inform integrated HIV/NCD care models. Although efforts to integrate care exist, further research is needed to optimize the efficacy of these programs.
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Basu P, Taghavi K, Hu SY, Mogri S, Joshi S. Management of cervical premalignant lesions. Curr Probl Cancer 2018; 42:129-136. [PMID: 29428790 DOI: 10.1016/j.currproblcancer.2018.01.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 12/27/2017] [Accepted: 01/10/2018] [Indexed: 01/08/2023]
Abstract
Treatment of cervical premalignant lesions (cervical intraepithelial neoplasia; CIN) of different grades is very effective, simple, and safe. The entire transformation zone of the cervix needs to be treated either by an ablative technique (cryotherapy or thermal ablation) or an excisional technique (large loop excision of transformation zone or cold knife conization); the choice of treatment depends on the size and location of the lesion and the type of the transformation zone. The cure rate after ablative treatment of high-grade CIN may be little lower than that after excisional treatment. The simplicity of the technique, low complication rate, and lesser cost make ablative technique the treatment of choice in the low resourced settings for the eligible lesions. In situations where organizing colposcopy and histopathology services is challenging, simple algorithms like screening with visual inspection with acetic acid test and immediate ablative treatment of the visual inspection with acetic acid-positive women has been recommended by the World Health Organization. Such a strategy is effective in preventing subsequent development of high-grade CIN and also ensures high compliance of the screen positive women to treatment.
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Affiliation(s)
- Partha Basu
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France.
| | - Katayoun Taghavi
- Institute of Social and Preventative medicine, University of Bern, Bern, Switzerland
| | - Shang-Ying Hu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sushma Mogri
- Department of Obstetrics and Gynecology, American International Institute of Medical Sciences, Udaipur, India
| | - Smita Joshi
- Jehangir Clinical Development Centre, Jehangir Hospital Premises and Prayas, Pune, India
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Roensbo MT, Blaakaer J, Skov K, Hammer A. Cervical HPV prevalence and genotype distribution in immunosuppressed Danish women. Acta Obstet Gynecol Scand 2017; 97:142-150. [PMID: 29156081 DOI: 10.1111/aogs.13261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 11/08/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Women receiving immunosuppressive treatment due to organ transplantation are at increased risk of Human papilloma virus (HPV)-related diseases, including cervical neoplasia. This pilot study aimed to describe the cervical HPV prevalence and genotype distribution in immunosuppressed Danish women. MATERIAL AND METHODS We included women who underwent renal (RTR) or bone marrow transplantation (BMTR) in 2009-2012 or 2014 at Aarhus University Hospital, Denmark. Women undergoing transplantation in 2009-2012 had one cervical cytology performed, whereas women undergoing transplantation in 2014 had three, one before and two after transplantation. The samples were examined for cytological abnormalities and tested for HPV using Cobas® HPV Test and CLART® HPV2 Test. RESULTS Of 94 eligible cases we included 60 RTR and BMTR. The overall prevalence of high-risk HPV was 15.0 [95% confidence interval (CI) 7.1-26.6] and the prevalence was higher among BMTR (29.4; 95% CI 10.3-56.0) than RTR (9.3%, 95% CI 2.6-22.1), although this was not statistically significant (p = 0.10). The distribution of high-risk HPV was broad, with HPV 45 as the most common genotype (3.3%). The prevalences of high-risk HPV types included in the bivalent/quadrivalent and the nonavalent vaccines were 1.7 and 8.3%, respectively. The prevalence of low-grade and high-grade cytological abnormalities was 6.7 and 5.0%, respectively. CONCLUSIONS Immunosuppressed women were infected with a broad range of high-risk HPV genotypes and the prevalence of cytological abnormalities was higher than found in previous studies of the general population. The nonavalent HPV vaccine will offer immunosuppressed individuals a greater protection against HPV-related diseases compared with the bivalent/quadrivalent HPV vaccines.
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Affiliation(s)
- Mette T Roensbo
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Emergency, Viborg Hospital, Viborg, Denmark
| | - Jan Blaakaer
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Karin Skov
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Hammer
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Herning Hospital, Herning, Denmark
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Cryotherapy Reduces Progression of Cervical Intraepithelial Neoplasia Grade 1 in South African HIV-Infected Women: A Randomized, Controlled Trial. J Acquir Immune Defic Syndr 2017; 76:532-538. [PMID: 28902073 DOI: 10.1097/qai.0000000000001539] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND HIV-infected women are at an increased risk of cervical cancer, especially in resource-limited countries. Cervical cancer prevention strategies focus treating cervical high-grade squamous intraepithelial lesions (HSIL). The management of low-grade squamous intraepithelial lesions (LSIL) in HIV-infected women is unknown. SETTING HIV treatment clinic in Johannesburg, South Africa. METHODS We randomized HIV-infected women with histologic cervical LSIL to cervical cryotherapy vs. no treatment (standard of care). Cervical high-risk human papillomavirus testing (hrHPV) was performed at baseline. All women underwent cervical cytology and colposcopic biopsies 12 months after enrollment. The primary end point was HSIL on histology at month 12. Chi-square was used to compare arms. RESULTS Overall, 220 HIV-infected women were randomized to cryotherapy (n = 112) or no treatment (n = 108). Median age was 38 years, 94% were receiving antiretroviral therapy; median CD4 was 499 cells per cubic millimeter, and 59% were hrHPV positive. Cryotherapy reduced progression to HSIL: 2/99 (2%) in the cryotherapy arm and 15/103 (15%) in the no treatment arm developed HSIL, 86% reduction (95% confidence interval: 41% to 97%; P = 0.002). Among 17 HSIL end points, 16 were hrHPV+ at baseline. When restricting the analysis to hrHPV+ women, HSIL occurred in 2/61 (3%) in the cryotherapy arm vs. 14/54 (26%) in the no treatment arm, 87% reduction (95% confidence interval: 47% to 97%; P = 0.0004). Participants in the cryotherapy arm experienced greater regression to normal histology and improved cytologic outcomes. CONCLUSIONS Treatment of cervical LSIL with cryotherapy decreased progression to HSIL among HIV-infected women especially if hrHPV positive. These results support treatment of LSIL in human papillomavirus test-and-treat approaches for cervical cancer prevention in resource-constrained settings.
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Kelly H, Weiss HA, Benavente Y, de Sanjose S, Mayaud P. Association of antiretroviral therapy with high-risk human papillomavirus, cervical intraepithelial neoplasia, and invasive cervical cancer in women living with HIV: a systematic review and meta-analysis. Lancet HIV 2017; 5:e45-e58. [PMID: 29107561 PMCID: PMC5757426 DOI: 10.1016/s2352-3018(17)30149-2] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 07/15/2017] [Accepted: 08/02/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The interactions between antiretroviral therapy (ART) and high-risk human papillomavirus (HPV) and cervical lesions in women living with HIV are poorly understood. We reviewed the association of ART with these outcomes. METHODS We did a systematic review and meta-analysis by searching MEDLINE and Embase databases for cross-sectional or cohort studies published in English between Jan 1, 1996, and May 6, 2017, which reported the association of ART with prevalence of high-risk HPV or prevalence, incidence, progression, or regression of histological or cytological cervical abnormalities, or incidence of invasive cervcal cancer. Studies were eligible if they reported the association of combination ART or highly active ART use with the following outcomes: high-risk HPV prevalence; squamous intraepithelial lesion (SIL) or cervical intraepithelial neoplasia (CIN) prevalence, incidence, progression, or regression; and invasive cervical cancer incidence among women living with HIV. We did random-effects meta-analyses to estimate summary statistics. We examined heterogeneity with the I2 statistic. This review is registered on the PROSPERO database at the Centre of Reviews and Dissemination, University of York, York, UK (registration number CRD42016039546). FINDINGS We identified 31 studies of the association of ART with prevalence of high-risk HPV (6537 women living with HIV) and high grade cervical lesions (HSIL-CIN2+; 9288 women living with HIV). Women living with HIV on ART had lower prevalence of high-risk HPV than did those not on ART (adjusted odds ratio [aOR] 0·83, 95% CI 0·70-0·99; I2=51%, adjusted for CD4 cell count and ART duration), and there was some evidence of association with HSIL-CIN2+ (0·65, 0·40-1·06; I2=30%). 17 studies reported the association of ART with longitudinal cervical lesion outcomes. ART was associated with a decreased risk of HSIL-CIN2+ incidence among 1830 women living with HIV (0·59, 0·40-0·87; I2=0%), SIL progression among 6212 women living with HIV (adjusted hazard ratio [aHR] 0·64, 95% CI 0·54-0·75; I2=18%), and increased likelihood of SIL or CIN regression among 5261 women living with HIV (1·54, 1·30-1·82; I2=0%). In three studies among 15 846 women living with HIV, ART was associated with a reduction in invasive cervical cancer incidence (crude HR 0·40, 95% CI 0·18-0·87, I2=33%). INTERPRETATION Early ART initiation and sustained adherence is likely to reduce incidence and progression of SIL and CIN and ultimately incidence of invasive cervical cancer. Future cohort studies should aim to confirm this possible effect. FUNDING UK Medical Research Council.
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Affiliation(s)
- Helen Kelly
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK,Correspondence to: Dr Helen Kelly, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UKCorrespondence to: Dr Helen Kelly, Department of Clinical ResearchFaculty of Infectious and Tropical DiseasesLondon School of Hygiene & Tropical MedicineLondonUK
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Yolanda Benavente
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Philippe Mayaud
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Obiri-Yeboah D, Akakpo PK, Mutocheluh M, Adjei-Danso E, Allornuvor G, Amoako-Sakyi D, Adu-Sarkodie Y, Mayaud P. Epidemiology of cervical human papillomavirus (HPV) infection and squamous intraepithelial lesions (SIL) among a cohort of HIV-infected and uninfected Ghanaian women. BMC Cancer 2017; 17:688. [PMID: 29037188 PMCID: PMC5644111 DOI: 10.1186/s12885-017-3682-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/10/2017] [Indexed: 11/29/2022] Open
Abstract
Background There is limited data in Ghana on the epidemiology of HPV and cervical neoplasia and their associations with HIV. This study aimed to compare among HIV-1 seropositive and HIV-seronegative Ghanaian women: (1) the prevalence, genotype distribution and risk factors associated with cervical HPV infection; and (2) the prevalence and risk factors associated with abnormal cervical cytology. Methods A comparative frequency-matched study was conducted in a systematic sample of women aged ≥18 years attending HIV and general outpatient clinics in Cape Coast Teaching Hospital, Ghana. Participants were interviewed and cervical samples collected for HPV genotyping (Seegene Anyplex-II HPV28) and cytological testing. Results Overall, 333 women were recruited, 163 HIV-1 seropositive and 170 HIV-seronegative women of mean age 43.8 years (SD ±9.4)) and 44.3 years (SD ±12.8), respectively. The prevalence of 14 high-risk (hr) HPV genotypes was higher among HIV-1 seropositive women (65.6% vs. 30.2%, P < 0.0001), as was proportion with multiple hr.-HPV infections (60.6% vs. 21.3%, P < 0.0001). HPV35 was the most prevalent hr.-HPV genotype in both groups (11.9% and 5.3%). The main factors associated with hr.-HPV infection were age for HIV-positive women and circumcision status of main sexual partner for both HIV-negative and positive women. Abnormal cervical cytology prevalence was higher among HIV-1 seropositive women (any SIL: 14.1% vs. 1.2%, P < 0.0001; low-grade SIL [LSIL]: 4.9% vs. 0.6%, P = 0.02; high-grade SIL: 1.8% vs. 0%, P = 0.07). Among HIV-1 seropositive women, number of pregnancies and CD4+ cell count were associated with LSIL+ cytology. There was strong association between LSIL+ abnormalities and HPV35 (aOR = 4.7, 95%CI: 1.3–17.7, P = 0.02). Conclusions HIV-1 infected women bear significant burden of HPV infection and related disease. Prevention and screening programmes should be specifically deployed for this population in Ghana. Electronic supplementary material The online version of this article (10.1186/s12885-017-3682-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Patrick K Akakpo
- Department of Pathology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Mohamed Mutocheluh
- Department of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Gloria Allornuvor
- Department of Obstetrics and Gynaecology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Daniel Amoako-Sakyi
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Yaw Adu-Sarkodie
- Department of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Philippe Mayaud
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Smith JS, Sanusi B, Swarts A, Faesen M, Levin S, Goeieman B, Ramotshela S, Rakhombe N, Williamson AL, Michelow P, Omar T, Hudgens MG, Firnhaber C. A randomized clinical trial comparing cervical dysplasia treatment with cryotherapy vs loop electrosurgical excision procedure in HIV-seropositive women from Johannesburg, South Africa. Am J Obstet Gynecol 2017; 217:183.e1-183.e11. [PMID: 28366730 DOI: 10.1016/j.ajog.2017.03.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/19/2017] [Accepted: 03/23/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Mortality associated with cervical cancer is a public health concern for women, particularly in HIV-seropositive women in resource-limited countries. HIV-seropositive women are at a higher risk of high-grade cervical precancer, which can eventually progress to invasive carcinoma as compared to HIV-seronegative women. It is imperative to identify effective treatment methods for high-grade cervical precursors among HIV-seropositive women. OBJECTIVE Randomized controlled trial data are needed comparing cryotherapy vs loop electrosurgical excision procedure treatment efficacy in HIV-seropositive women. Our primary aim was to compare the difference in the efficacy of loop electrosurgical excision procedure vs cryotherapy for the treatment of high-grade cervical intraepithelial neoplasia (grade ≥2) among HIV-seropositive women by conducting a randomized clinical trial. STUDY DESIGN HIV-seropositive women (n = 166) aged 18-65 years with histology-proven cervical intraepithelial neoplasia grade ≥2 were randomized (1:1) to cryotherapy or loop electrosurgical excision procedure treatment at a government hospital in Johannesburg. Treatment efficacy was compared using 6- and 12-month cumulative incidence posttreatment of: (1) cervical intraepithelial neoplasia grade ≥2; (2) secondary endpoints of histologic cervical intraepithelial neoplasia grade ≥3 and grade ≥1; and (3) high-grade and low-grade cervical cytology. The study was registered (ClinicalTrials.govNCT01723956). RESULTS From January 2010 through August 2014, 166 participants were randomized (86 loop electrosurgical excision procedure; 80 cryotherapy). Cumulative cervical intraepithelial neoplasia grade ≥2 incidence was higher for cryotherapy (24.3%; 95% confidence interval, 16.1-35.8) than loop electrosurgical excision procedure at 6 months (10.8%; 95% confidence interval, 5.7-19.8) (P = .02), although by 12 months, the difference was not significant (27.2%; 95% confidence interval, 18.5-38.9 vs 18.5%; 95% confidence interval, 11.6-28.8, P = .21). Cumulative cervical intraepithelial neoplasia grade ≥1 incidence for cryotherapy (89.2%; 95% confidence interval, 80.9-94.9) did not differ from loop electrosurgical excision procedure (78.3%; 95% confidence interval, 68.9-86.4) at 6 months (P = .06); cumulative cervical intraepithelial neoplasia grade ≥1 incidence by 12 months was higher for cryotherapy (98.5%; 95% confidence interval, 92.7-99.8) than loop electrosurgical excision procedure (89.8%; 95% confidence interval, 82.1-95.2) (P = .02). Cumulative high-grade cytology incidence was higher for cryotherapy (41.9%) than loop electrosurgical excision procedure at 6 months (18.1%, P < .01) and 12 months (44.8% vs 19.4%, P < .001). Cumulative incidence of low-grade cytology or greater in cryotherapy (90.5%) did not differ from loop electrosurgical excision procedure at 6 months (80.7%, P = .08); by 12 months, cumulative incidence of low-grade cytology or greater was higher in cryotherapy (100%) than loop electrosurgical excision procedure (94.8%, P = .03). No serious adverse effects were recorded. CONCLUSION Although rates of cumulative cervical intraepithelial neoplasia grade ≥2 were lower after loop electrosurgical excision procedure than cryotherapy treatment at 6 months, both treatments appeared effective in reducing cervical intraepithelial neoplasia grade ≥2 by >70% by 12 months. The difference in cumulative cervical intraepithelial neoplasia grade ≥2 incidence between the 2 treatment methods by 12 months was not statistically significant. Relatively high cervical intraepithelial neoplasia grade ≥2 recurrence rates, indicating treatment failure, were observed in both treatment arms by 12 months. A different treatment protocol should be considered to optimally treat cervical intraepithelial neoplasia grade ≥2 in HIV-seropositive women.
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Kelly HA, Ngou J, Chikandiwa A, Sawadogo B, Gilham C, Omar T, Lompo O, Doutre S, Meda N, Weiss HA, Delany-Moretlwe S, Segondy M, Mayaud P. Associations of Human Papillomavirus (HPV) genotypes with high-grade cervical neoplasia (CIN2+) in a cohort of women living with HIV in Burkina Faso and South Africa. PLoS One 2017; 12:e0174117. [PMID: 28333966 PMCID: PMC5363860 DOI: 10.1371/journal.pone.0174117] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 03/04/2017] [Indexed: 12/29/2022] Open
Abstract
Objective To describe associations of high-risk human papillomavirus (HR-HPV) with high-grade cervical intraepithelial neoplasia (CIN2+) in women living with HIV (WLHIV) in Burkina Faso (BF) and South Africa (SA). Methods Prospective cohort of WLHIV attending HIV outpatient clinics and treatment centres. Recruitment was stratified by ART status. Cervical HPV genotyping using INNO-LiPA and histological assessment of 4-quadrant cervical biopsies at enrolment and 16 months later. Results Among women with CIN2+ at baseline, the prevalence of any HR-HPV genotypes included in the bi/quadrivalent (HPV16/18) or nonavalent (HPV16/18/31/35/45/52/58) HPV vaccines ranged from 37% to 90%. HPV58 was most strongly associated with CIN2+ (aOR = 5.40, 95%CI: 2.77–10.53). At 16-months follow-up, persistence of any HR-HPV was strongly associated with incident CIN2+ (aOR = 7.90, 95%CI: 3.11–20.07), as was persistence of HPV16/18 (aOR = 5.25, 95%CI: 2.14–12.91) and the additional HR types in the nonavalent vaccine (aOR = 3.23, 95%CI: 1.23–8.54). Conclusion HR-HPV persistence is very common among African WLHIV and is linked to incident CIN2+. HPV vaccines could prevent between 37–90% of CIN2+ among African WLHIV.
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Affiliation(s)
- Helen A Kelly
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jean Ngou
- INSERM U1058 and University Hospital (CHRU), Montpellier, France
| | - Admire Chikandiwa
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Bernard Sawadogo
- Centre de Recherches Internationales en Santé, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Clare Gilham
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tanvier Omar
- National Health Laboratory Services, Johannesburg, South Africa
| | - Olga Lompo
- Centre de Recherches Internationales en Santé, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Sylviane Doutre
- INSERM U1058 and University Hospital (CHRU), Montpellier, France
| | - Nicolas Meda
- Centre de Recherches Internationales en Santé, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Helen A Weiss
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.,MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Michel Segondy
- INSERM U1058 and University Hospital (CHRU), Montpellier, France
| | - Philippe Mayaud
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
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Delory T, Ngo-Giang-Huong N, Rangdaeng S, Chotivanich N, Limtrakul A, Putiyanun C, Suriyachai P, Matanasarawut W, Jarupanich T, Liampongsabuddhi P, Heard I, Jourdain G, Lallemant M, Le Coeur S. Human Papillomavirus infection and cervical lesions in HIV infected women on antiretroviral treatment in Thailand. J Infect 2017; 74:501-511. [PMID: 28254419 DOI: 10.1016/j.jinf.2017.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/19/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To estimate the prevalence and factors associated with Human Papillomavirus (HPV) infection, HPV genotypes and cytological/histological high-grade (HSIL+/CIN2+) lesions. METHODS We conducted a cross-sectional study within a prospective cohort of HIV-infected women on combination antiretroviral therapy (cART). Cervical specimens were collected for cytology and HPV genotyping (Papillocheck®). Any women with High-Risk-HPV (HR-HPV), and/or potentially HR-HPV (pHR-HPV) and/or ASC-US or higher (ASC-US+) lesions were referred for colposcopy. Factors associated with HR-HPV infection and with HSIL+/CIN2+ lesions were investigated using mixed-effects logistic regression models. RESULTS 829 women were enrolled: median age 40.4 years, on cART for a median of 6.9 years, median CD4 cell-count 536 cells/mm3, and 788 (96%) with HIV-viral load<50copies/mL. Of 214 (26%) infected with HPV: 159 (19%) had ≥1 HR-HPV, of whom 38 (5%) HPV52, 22 (3%) HPV16, 9 (1%) HPV18; 21 (3%) had pHR-HPV, 34 (4%) low risk-HPV infection, and 56 (26%) had multiple genotypes. Younger age, low CD4 cell-counts and low education were independently associated with HR-HPV infection. 72 women (9%) had ASC-US+ and 28 (3%) HSIL+/CIN2+ lesions. HR-HPV infection was independently associated with HSIL+/CIN2+ lesions. CONCLUSION The prevalence of HPV infection and of cervical lesions was low. The HPV genotype distribution supports the use of 9-valent vaccine in Thailand.
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Affiliation(s)
- Tristan Delory
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; APHP, Service de maladies infectieuses et tropicales, hôpital Saint Louis, F-75010, Paris, France; Institut National d'Etudes Démographiques (Ined), UR-5, Paris, France.
| | - Nicole Ngo-Giang-Huong
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Samreung Rangdaeng
- Faculty of Medicine, Department of Pathology, Chiang Mai University, Chiang Mai, Thailand
| | | | - Aram Limtrakul
- Ministry of Public Health, Nakornping Hospital, Chiang Mai, Thailand
| | - Chaiwat Putiyanun
- Ministry of Public Health, Chiang Kham Hospital, Chiang Kham, Thailand
| | | | | | | | | | - Isabelle Heard
- HPV National Reference Center, Pasteur Institute, Paris, France; APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Gonzague Jourdain
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Marc Lallemant
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sophie Le Coeur
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Institut National d'Etudes Démographiques (Ined), UR-5, Paris, France; Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Katz IT, Butler LM, Crankshaw TL, Wright AA, Bramhill K, Leone DA, Giddy J, Mould S. Cervical Abnormalities in South African Women Living With HIV With High Screening and Referral Rates. J Glob Oncol 2016; 2:375-380. [PMID: 28717723 PMCID: PMC5493244 DOI: 10.1200/jgo.2015.002469] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To determine the prevalence of screening, cervical dysplasia, and malignancy on the basis of histologic diagnoses from colposcopy and large loop excision of the transformation zone among women living with HIV (WLWH) who attended an urban antiretroviral treatment (ART) clinic in KwaZulu-Natal, South Africa. MATERIALS AND METHODS We performed a retrospective cohort study to examine a random sample of 462 WLWH during a 5-year period from 2004 to 2009. Women on ART for < 3 months were excluded. Data were abstracted from electronic records and paper charts to assess rates of cervical abnormalities detected on Pap smears as well as time to colposcopy. RESULTS During the study period, 432 women (93.5%) had at least one evaluable Papanicolau test. At baseline, 237 women (54.9%) had an abnormal Papanicolau test, and of these patients, 181 (76.3%) had a Papanicolau test that qualified for further colposcopic evaluation. In addition, 115 women (63.5%) received colposcopy within a median of 39 days from referral. This yielded 74 evaluable histologic samples (64.3%), of which 21.6%, 27.0%, 27.0%, and 1.4% had cervical intraepithelial neoplasia (CIN) 1, CIN2, CIN3, and invasive cervical cancer, respectively. CONCLUSION In a large sample of WLWH who received ART in KwaZulu-Natal, South Africa, where Papanicolau test coverage and rates of referral for colposcopy and large loop excision of the transformation zone were high, > 75% of women with evaluable histologic samples had evidence of cervical dysplasia or malignancy. These findings underscore the importance of routine cervical screening upon entry into HIV care to optimize survival.
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Affiliation(s)
- Ingrid T. Katz
- Ingrid T. Katz and Dominick A. Leone, Brigham and Women’s Hospital; Ingrid T. Katz, Lisa M. Butler, and Alexi A. Wright, Harvard Medical School; Ingrid T. Katz, Massachusetts General Hospital Center for Global Health; Lisa M. Butler, Boston Children’s Hospital; Alexi A. Wright, Dana-Farber Cancer Institute; Dominick A. Leone, Boston University, Boston, MA; Tamaryn L. Crankshaw, University of KwaZulu-Natal, Durban; Janet Giddy, Western Cape Province Department of Health, Cape Town; Sean Mould, R.K. Khan Hospital, Chatsworth, South Africa; and Karen Bramhill, Canadian Red Cross, Ontario, Canada
| | - Lisa M. Butler
- Ingrid T. Katz and Dominick A. Leone, Brigham and Women’s Hospital; Ingrid T. Katz, Lisa M. Butler, and Alexi A. Wright, Harvard Medical School; Ingrid T. Katz, Massachusetts General Hospital Center for Global Health; Lisa M. Butler, Boston Children’s Hospital; Alexi A. Wright, Dana-Farber Cancer Institute; Dominick A. Leone, Boston University, Boston, MA; Tamaryn L. Crankshaw, University of KwaZulu-Natal, Durban; Janet Giddy, Western Cape Province Department of Health, Cape Town; Sean Mould, R.K. Khan Hospital, Chatsworth, South Africa; and Karen Bramhill, Canadian Red Cross, Ontario, Canada
| | - Tamaryn L. Crankshaw
- Ingrid T. Katz and Dominick A. Leone, Brigham and Women’s Hospital; Ingrid T. Katz, Lisa M. Butler, and Alexi A. Wright, Harvard Medical School; Ingrid T. Katz, Massachusetts General Hospital Center for Global Health; Lisa M. Butler, Boston Children’s Hospital; Alexi A. Wright, Dana-Farber Cancer Institute; Dominick A. Leone, Boston University, Boston, MA; Tamaryn L. Crankshaw, University of KwaZulu-Natal, Durban; Janet Giddy, Western Cape Province Department of Health, Cape Town; Sean Mould, R.K. Khan Hospital, Chatsworth, South Africa; and Karen Bramhill, Canadian Red Cross, Ontario, Canada
| | - Alexi A. Wright
- Ingrid T. Katz and Dominick A. Leone, Brigham and Women’s Hospital; Ingrid T. Katz, Lisa M. Butler, and Alexi A. Wright, Harvard Medical School; Ingrid T. Katz, Massachusetts General Hospital Center for Global Health; Lisa M. Butler, Boston Children’s Hospital; Alexi A. Wright, Dana-Farber Cancer Institute; Dominick A. Leone, Boston University, Boston, MA; Tamaryn L. Crankshaw, University of KwaZulu-Natal, Durban; Janet Giddy, Western Cape Province Department of Health, Cape Town; Sean Mould, R.K. Khan Hospital, Chatsworth, South Africa; and Karen Bramhill, Canadian Red Cross, Ontario, Canada
| | - Karen Bramhill
- Ingrid T. Katz and Dominick A. Leone, Brigham and Women’s Hospital; Ingrid T. Katz, Lisa M. Butler, and Alexi A. Wright, Harvard Medical School; Ingrid T. Katz, Massachusetts General Hospital Center for Global Health; Lisa M. Butler, Boston Children’s Hospital; Alexi A. Wright, Dana-Farber Cancer Institute; Dominick A. Leone, Boston University, Boston, MA; Tamaryn L. Crankshaw, University of KwaZulu-Natal, Durban; Janet Giddy, Western Cape Province Department of Health, Cape Town; Sean Mould, R.K. Khan Hospital, Chatsworth, South Africa; and Karen Bramhill, Canadian Red Cross, Ontario, Canada
| | - Dominick A. Leone
- Ingrid T. Katz and Dominick A. Leone, Brigham and Women’s Hospital; Ingrid T. Katz, Lisa M. Butler, and Alexi A. Wright, Harvard Medical School; Ingrid T. Katz, Massachusetts General Hospital Center for Global Health; Lisa M. Butler, Boston Children’s Hospital; Alexi A. Wright, Dana-Farber Cancer Institute; Dominick A. Leone, Boston University, Boston, MA; Tamaryn L. Crankshaw, University of KwaZulu-Natal, Durban; Janet Giddy, Western Cape Province Department of Health, Cape Town; Sean Mould, R.K. Khan Hospital, Chatsworth, South Africa; and Karen Bramhill, Canadian Red Cross, Ontario, Canada
| | - Janet Giddy
- Ingrid T. Katz and Dominick A. Leone, Brigham and Women’s Hospital; Ingrid T. Katz, Lisa M. Butler, and Alexi A. Wright, Harvard Medical School; Ingrid T. Katz, Massachusetts General Hospital Center for Global Health; Lisa M. Butler, Boston Children’s Hospital; Alexi A. Wright, Dana-Farber Cancer Institute; Dominick A. Leone, Boston University, Boston, MA; Tamaryn L. Crankshaw, University of KwaZulu-Natal, Durban; Janet Giddy, Western Cape Province Department of Health, Cape Town; Sean Mould, R.K. Khan Hospital, Chatsworth, South Africa; and Karen Bramhill, Canadian Red Cross, Ontario, Canada
| | - Sean Mould
- Ingrid T. Katz and Dominick A. Leone, Brigham and Women’s Hospital; Ingrid T. Katz, Lisa M. Butler, and Alexi A. Wright, Harvard Medical School; Ingrid T. Katz, Massachusetts General Hospital Center for Global Health; Lisa M. Butler, Boston Children’s Hospital; Alexi A. Wright, Dana-Farber Cancer Institute; Dominick A. Leone, Boston University, Boston, MA; Tamaryn L. Crankshaw, University of KwaZulu-Natal, Durban; Janet Giddy, Western Cape Province Department of Health, Cape Town; Sean Mould, R.K. Khan Hospital, Chatsworth, South Africa; and Karen Bramhill, Canadian Red Cross, Ontario, Canada
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Badkur P, Singh KN, Ghanghoriya V. Colposcopic Study of Lower Genital Tract Infections in HIV-Positive Women on Antiretroviral Therapy. J Obstet Gynaecol India 2016; 66:471-7. [PMID: 27651648 PMCID: PMC5016449 DOI: 10.1007/s13224-016-0852-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 01/25/2016] [Indexed: 10/22/2022] Open
Abstract
AIMS AND OBJECTIVES To study the colposcopic findings and prevalence of lower genital tract infections in HIV-positive women on anti-retroviral therapy. To find correlation between colposcopic finding, m RNA HPV and cytology of lower genital tract infections in HIV-positive women on anti-retroviral therapy. MATERIALS AND METHODS The present prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Netaji Subhash Chandra Bose Medical College, Jabalpur, from 1 June 2013 to 31 October 2014. The data of the present study was recorded into computer and after proper validation, error checking, coding and decoding, the data was compiled and analysed using the SPSS Windows. Appropriate univariate and bivariate analysis were carried out using the Student's t test and two-tailed Fisher exact test or Chi-square test for categorical variables. RESULTS AND CONCLUSION The present study concludes that the prevalence of lower genital tract infections is 25.3 % in HIV-positive women on anti-retroviral therapy. It revealed that 35 HIV-positive women on anti-retroviral therapy who were screened for m HPV RNA test, one came out to be positive (i.e. 2.8 %); thus, it can be said that there is an increased clearance of oncogenic HPV types in HIV-positive women on anti-retroviral therapy.
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Affiliation(s)
- Poorva Badkur
- Department of Obstetrics and Gynaecology, NSCB Government Medical College, Jabalpur, Madhya Pradesh India
| | - Kavita N. Singh
- Department of Obstetrics and Gynaecology, NSCB Government Medical College, Jabalpur, Madhya Pradesh India
- Tata Memorial Hospital Mumbai, Mumbai, India
- RCC Trivendrum, Trivendrum, India
- RPCI, Buffalo, NY USA
- Advanced Colposcopy Centre, Jabalpur, Madhya Pradesh India
| | - Vineeta Ghanghoriya
- Department of Obstetrics and Gynaecology, NSCB Government Medical College, Jabalpur, Madhya Pradesh India
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Thunga S, Andrews A, Ramapuram J, Satyamoorthy K, Kini H, Unnikrishnan B, Adhikari P, Singh P, Kabekkodu SP, Bhat S, Kadam A, Shetty AK. Cervical cytological abnormalities and human papilloma virus infection in women infected with HIV in Southern India. J Obstet Gynaecol Res 2016; 42:1822-1828. [PMID: 27641071 DOI: 10.1111/jog.13111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 03/21/2016] [Accepted: 06/18/2016] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to examine the association between CD4 count, human papilloma virus (HPV) infection, and the risk of cervical intraepithelial neoplasia among HIV-infected women. METHODS A cross-sectional study was conducted among 104 HIV-infected women attending an antiretroviral therapy clinic. They underwent Pap smear and cervical HPV DNA testing. RESULTS The overall prevalence of HPV infection was 57.7%. HPV 16 was the commonest genotype found (38.5%); HPV 16 and 18 put together contributed to 73.3% of HPV infection; 27.5% of HIV-infected women had squamous cell abnormalities. Cervical intraepithelial neoplasia was less likely among women with CD4 count > 500/mm3 (12%) and in those without opportunistic infections (17.8%). The prevalence of high-risk HPV infection was higher in women with high-grade squamous intraepithelial lesions or greater lesions (85.7%) as compared to women with normal cytology (52.1%). CONCLUSION The high prevalence of HPV infection and cervical intraepithelial neoplasia in HIV-infected women warrants the need for regular Pap smear screening in these women and routine HPV vaccination for adolescents to reduce the burden of cervical cancer in India.
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Affiliation(s)
- Suchitra Thunga
- Department of OBG, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | | | - John Ramapuram
- Department of Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Kapaettu Satyamoorthy
- Centre for Molecular and Cellular Biology, School of Life Sciences, Manipal University, Karnataka, India
| | - Hema Kini
- Department of Pathology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - B Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Prabha Adhikari
- Department of Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Prakhar Singh
- Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Shama Prasada Kabekkodu
- Department of Biotechnology, School of Life Sciences, Manipal University, Manipal, Karnataka, India
| | - Samatha Bhat
- Department of Biotechnology, School of Life Sciences, Manipal University, Manipal, Karnataka, India
| | - Anagha Kadam
- Department of Biotechnology, School of Life Sciences, Manipal University, Manipal, Karnataka, India
| | - Avinash K Shetty
- Department of Pediatrics, Wake Forest School of Medicine, Salem, North Carolina, USA
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31
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Performance of careHPV for detecting high-grade cervical intraepithelial neoplasia among women living with HIV-1 in Burkina Faso and South Africa: HARP study. Br J Cancer 2016; 115:425-30. [PMID: 27434037 PMCID: PMC4985351 DOI: 10.1038/bjc.2016.207] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 05/12/2016] [Accepted: 06/12/2016] [Indexed: 01/12/2023] Open
Abstract
Background: The careHPV assay is a test for high-risk (HR) human papillomaviruses (HPV) detection designed to be affordable in resource-poor settings. We evaluated the performance of careHPV screening among 1052 women living with HIV/AIDS included in the HARP (HPV in Africa Research Partnership) study in Burkina Faso (BF) and South Africa (SA). Methods: Cervical samples were tested for HR-HPV by the careHPV and the INNO-LiPA HPV genotyping Extra assays. All women had Pap smear testing, visual inspection with acetic acid/Lugol's iodine (VIA/VILI) and colposcopy. Cervical biopsies were obtained for participants who were HR-HPV DNA positive by careHPV or who had abnormalities detected on cytology, VIA/VILI or colposcopy. Results: Overall, 45.1% of women had a positive careHPV test (46.5% in BF, 43.8% in SA). The careHPV positivity rate increased with the grade of cytological lesions. Sensitivity and specificity of careHPV for the diagnosis of CIN2+ (n=60, both countries combined) were 93.3% (95% confidence interval (CI): 83.8–98.2) and 57.9% (95% CI: 54.5–61.2), respectively. Specificity increased with CD4 count. careHPV had a similar clinical sensitivity but higher specificity than the INNO-LiPA assay for detection of CIN2+. Conclusions: Our results suggest that careHPV testing is a reliable tool for cervical cancer screening in HIV-1-infected women in sub-Saharan Africa.
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Carlander C, Wagner P, Svedhem V, Elfgren K, Westling K, Sönnerborg A, Sparén P. Impact of immunosuppression and region of birth on risk of cervical intraepithelial neoplasia among migrants living with HIV in Sweden. Int J Cancer 2016; 139:1471-9. [PMID: 27177207 DOI: 10.1002/ijc.30188] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 04/20/2016] [Accepted: 05/02/2016] [Indexed: 11/09/2022]
Abstract
Little is known about the incidence and risk of cervical intraepithelial neoplasia (CIN) grade 3, adenocarcinoma in situ and invasive cervical cancer (CIN3+) among migrants living with HIV in a European setting. We assessed the cumulative incidence (CuI) and hazard ratio (HR) of CIN2+ and CIN3+ in a cohort of women living with HIV (WLWH) (n = 893) identified from the Swedish national HIV register and HIV-negative women (n = 205,842) identified from the Swedish Population Register, matched on region of birth and age. Data was collected between 1993 and 2011 by linking our cohort with the Swedish National Cervical Screening Registry, collecting all cytological and histological results since 1993. The CuI of CIN3+ was 13.1% [95% confidence interval (CI) 8.9-17.2] for WLWH and 2.1% (95% CI 2.0-2.2) for HIV-negative after 18 years of follow-up. WLWH had more than eight times higher, age and region of birth matched, risk of CIN3+ than HIV-negative (HR 8.8: 95% CI 6.9-11.3). WLWH born in the East region, dominated by Thai women, had a two times higher risk of CIN3+ compared with WLWH born in Sweden (HR 2.47: 95% CI 1.2-5.0), which remained after adjusting for immunosuppression. Our results showed a substantially increased risk of CIN3+ among WLWH, which differed depending on birth region. Early HIV diagnosis and attendance to cervical cancer screening, with focus on migrants, is of crucial importance to minimize the incidence of cervical intraepithelial neoplasia.
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Affiliation(s)
- Christina Carlander
- Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research, County Hospital Västerås, Västerås, Sweden
| | - Philippe Wagner
- Centre for Clinical Research, County Hospital Västerås, Västerås, Sweden
| | - Veronica Svedhem
- Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Elfgren
- CLINTEC, Department of Obstetrics and Gynaecology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Katarina Westling
- Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Anders Sönnerborg
- Unit of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Pillay P, van Lieshout L, Taylor M, Sebitloane M, Zulu SG, Kleppa E, Roald B, Kjetland EF. Cervical cytology as a diagnostic tool for female genital schistosomiasis: Correlation to cervical atypia and Schistosoma polymerase chain reaction. Cytojournal 2016; 13:10. [PMID: 27168759 PMCID: PMC4854169 DOI: 10.4103/1742-6413.180784] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/20/2015] [Indexed: 11/25/2022] Open
Abstract
Background: Female genital schistosomiasis (FGS) is a tissue reaction to lodged ova of Schistosoma haematobium in the genital mucosa. Lesions can make the mucosa friable and prone to bleeding and discharge. Women with FGS may have an increased risk of HIV acquisition, and FGS may act as a cofactor in the development of cervical cancer. Objectives: To explore cytology as a method for diagnosing FGS and to discuss the diagnostic challenges in low-resource rural areas. The correlation between FGS and squamous cell atypia (SCA) is also explored and discussed. Cytology results are compared to Schistosoma polymerase chain reaction (PCR) in vaginal lavage and urine and in urine microscopy. Materials and Methods: In a clinical study, 394 women aged between 16 and 23 years from rural high schools in KwaZulu-Natal, South Africa, underwent structured interviews and the following laboratory tests: Cytology Papanicolaou (Pap) smears for S. haematobium ova and cervical SCA, real-time PCR for Schistosoma-specific DNA in vaginal lavage and urine samples, and urine microscopy for the presence of S. haematobium ova. Results: In Pap smears, S. haematobium ova were detected in 8/394 (2.0%). SCA was found in 107/394 (27.1%), seven of these had high-grade squamous intraepithelial lesion (HSIL). Schistosoma specific DNA was detected in 38/394 (9.6%) of vaginal lavages and in 91/394 (23.0%) of urines. Ova were found microscopically in 78/394 (19.7%) of urines. Conclusion: Schistosoma PCR on lavage was a better way to diagnose FGS compared to cytology. There was a significant association between S. haematobium ova in Pap smears and the other diagnostic methods. In low-resource Schistosoma-endemic areas, it is important that cytology screeners are aware of diagnostic challenges in the identification of schistosomiasis in addition to the cytological diagnosis of SCA. Importantly, in this study, three of eight urines were negative but showed Schistosoma ova in their Pap smear, and one of them was also negative for Schistosoma DNA in urine. In this study, SCA was not significantly associated with schistosomiasis. HSIL detected in this young population might need future consideration.
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Affiliation(s)
- Pavitra Pillay
- Address: Department of Biomedical and Clinical Technology, Durban University of Technology, KwaZulu-Natal, Durban, South Africa; Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Myra Taylor
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Motshedisi Sebitloane
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Siphosenkosi Gift Zulu
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Elisabeth Kleppa
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Infectious Diseases, Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway
| | - Borghild Roald
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Eyrun Floerecke Kjetland
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; Department of Infectious Diseases, Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway
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Mbulawa ZZA, Wilkin TJ, Goeieman B, Swarts A, Williams S, Levin S, Faesen M, Smith JS, Chibwesha CJ, Williamson AL, Firnhaber C. Xpert human papillomavirus test is a promising cervical cancer screening test for HIV-seropositive women. ACTA ACUST UNITED AC 2016; 2:56-60. [PMID: 29074186 PMCID: PMC5886871 DOI: 10.1016/j.pvr.2016.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/09/2016] [Accepted: 02/29/2016] [Indexed: 11/30/2022]
Abstract
This study investigated the performance of Cepheid Xpert human papillomavirus (HPV) assay in South African human immunodeficiency virus (HIV)-infected women and compared its performance with that of hybrid capture-2 (hc2). Methods: Stored cervical specimens from HIV-infected women that had previously been tested using hc2 were tested using Xpert. Results: The overall HR-HPV prevalence was found to be 62.0% (720/1161) by Xpert and 61.2% (711/1161) by hc2. 13.6% (158/1161) were HPV16 positive, 18.8% (218/1161) were HPV18/45, 37.3% (434/1161) were HPV31/33/35/52/58, 12.7% (147/1161) were HPV51/59 and 23.3% (270/1161) were HPV39/68/56/66. Overall agreement with hc2 was 90%; Cohen’s kappa was 0.78 (95% CI 0.74–0.82) indicating substantial agreement. Detection of HPV16, HPV18/45, and HPV31/33/35/52/58 were independently associated with cervical intraepithelial neoplasia (CIN)−2+ (P<0.0001 for each); while HPV51/59 and HPV39/68/56/66 were not. Women infected with HPV16, HPV18/45 or HPV31/33/35/52/58 were found to have significantly higher amounts of HPV DNA detected for those with CIN2+ compared to those without CIN2+, P<0.0001 for each. Xpert and hc2 were similarly sensitive (88.3% and 91.5%, respectively) and specific (48.4% and 51.0%) for CIN2+ and CIN3 (sensitivity: 95.8% and 97.9%; specificity: 41.4% and 42.8%). Conclusions: Xpert is a promising screening test in HIV-infected women that performs similarly to hc2.
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Affiliation(s)
- Zizipho Z A Mbulawa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa; Centre for HIV and STIs, National Institute for Communicable Disease, National Health Laboratory Service, South Africa.
| | - Timothy J Wilkin
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | | | - Avril Swarts
- Clinical HIV Research Unit, Department of Medicine, University of the Witswatersand, Johannesburg, South Africa.
| | | | | | | | - Jennifer S Smith
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Carla J Chibwesha
- Right to Care, Johannesburg, South Africa; Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapell Hill, NC, USA.
| | - Anna-Lise Williamson
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa; UCT-SAMRC Clinical Gynaecological Cancer Research Centre, University of Cape Town, South Africa; National Health Laboratory Service, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa.
| | - Cynthia Firnhaber
- Right to Care, Johannesburg, South Africa; Clinical HIV Research Unit, Department of Medicine, University of the Witswatersand, Johannesburg, South Africa.
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Lim J, Ojo A. Barriers to utilisation of cervical cancer screening in Sub Sahara Africa: a systematic review. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12444] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 11/30/2022]
Affiliation(s)
- J.N.W. Lim
- Faculty of Medical Science; Anglia Ruskin University; Cambridge Campus UK
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Michelow P, Sherrin A, Rossouw L, Mohaleamolla S, Evans D, Swarts A, Rakhombe N, Smith JS, Firnhaber C. Performance of the Cellslide ® automated liquid-based cytology system amongst HIV-positive women. Afr J Lab Med 2016; 5:278. [PMID: 28879102 PMCID: PMC5436391 DOI: 10.4102/ajlm.v5i1.278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/13/2015] [Indexed: 11/24/2022] Open
Abstract
Background Many women undergoing cervical screening as part of a national South African screening programme may be positive for HIV. The performance of liquid-based cytology (LBC) on samples from HIV-positive women needs to be determined. Objectives The performance of the Cellslide® automated LBC system was evaluated as a possible alternative to conventional cytology in a national cervical cancer screening programme. Methods Split samples from 348 HIV-positive women attending an HIV treatment clinic in Johannesburg, South Africa were examined by conventional cytology and monolayer LBC methods. All samples were stained, examined and reported in the same manner. Cytotechnologists were blinded to the conventional smear diagnosis if the LBC smear was screened and vice versa. Results The same percentage of inadequate smears (1.4%) was obtained by conventional cytology and LBC. Atypical squamous cells of undetermined significance were observed in 5.2% of conventional smears and 4.0% of LBC smears. Low-grade squamous intraepithelial lesions were found in 35.6% of conventional smears and 32.7% of LBC smears. Only one conventional smear was categorised as atypical squamous cells – cannot exclude a high-grade lesion, whereas five such cases were identified on LBC. High-grade squamous intraepithelial lesions were seen in 21.6% of conventional smears and 23.3% LBC smears. No invasive carcinoma was identified. Conclusion The performance of the Cellslide® LBC system was similar to that of conventional cytology in this population of high-risk HIV-positive women, indicating that it may be introduced successfully as part of a cervical cancer screening programme.
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Affiliation(s)
- Pamela Michelow
- Department of Anatomical Pathology, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Amanda Sherrin
- Department of Anatomical Pathology, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Louise Rossouw
- Department of Anatomical Pathology, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Samson Mohaleamolla
- Department of Anatomical Pathology, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Denise Evans
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Avril Swarts
- Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jennifer S Smith
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Cynthia Firnhaber
- Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Right to Care, Helen Joseph Hospital, Johannesburg, South Africa
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Papasavvas E, Surrey LF, Glencross DK, Azzoni L, Joseph J, Omar T, Feldman MD, Williamson AL, Siminya M, Swarts A, Yin X, Liu Q, Firnhaber C, Montaner LJ. High-risk oncogenic HPV genotype infection associates with increased immune activation and T cell exhaustion in ART-suppressed HIV-1-infected women. Oncoimmunology 2016; 5:e1128612. [PMID: 27467943 DOI: 10.1080/2162402x.2015.1128612] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022] Open
Abstract
Persistence of human papillomavirus (HPV) and cervical disease in the context of HIV co-infection can be influenced by introduction of antiretroviral therapy (ART) and sustained immune activation despite ART. We conducted a cross-sectional study in order to evaluate immune activation/exhaustion in ART-suppressed HIV(+) women with or without high-risk (HR) HPV-related cervical intraepithelial neoplasia (CIN). 55 South African women were recruited in three groups: HR (-) (n = 16) and HR (+) (n = 15) HPV with negative cervical histopathology, and HR (+) HPV with CIN grade 1/2/3 (n = 24). Sampling included endocervical brushing (HPV DNA genotyping), Pap smear (cytology), colposcopic punch biopsy (histopathology, histochemical evaluation of immune cells), and peripheral blood (clinical assessment, flow cytometry-based immune subset characterization). Statistics were done using R2.5.1. Irrespective of the presence of CIN, HR (+) HPV women had higher circulating levels of T cells expressing markers of activation/exhaustion (CD38, PD1, CTLA-4, BTLA, CD160), Tregs, and myeloid subsets expressing corresponding ligands (PDL1, PDL2, CD86, CD40, HVEM) than HR (-) HPV women. A decrease in circulating NK cells was associated with CIN grade. CD4(+) T cell count associated negatively with T cell exhaustion and expression of negative regulators on myeloid cells. Women with CIN when compared to HR (-) HPV women, had higher cervical cell density in stroma and epithelium for CD4(+), CD68(+), and CD11c(+) cells, and only in stroma for CD8(+) cells. We conclude that in ART-suppressed HIV-infected women with HPV co-infection the levels of T and myeloid cell activation/exhaustion are associated with the presence of HR HPV genotypes.
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Affiliation(s)
| | - Lea F Surrey
- Division of Molecular Pathology, Hospital of the University of Pennsylvania , Philadelphia, PA, USA
| | - Deborah K Glencross
- Faculty of Health Science Department of Molecular Medicine and Haematology, University of Witwatersrand, Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa
| | | | | | - Tanvier Omar
- National Health Laboratory Service, Johannesburg, South Africa; Faculty of Health Science Department of Anatomical Pathology, University of Witwatersrand, Johannesburg, South Africa
| | - Michael D Feldman
- Division of Surgical Pathology, Hospital of the University of Pennsylvania , Philadelphia, PA, USA
| | - Anna-Lise Williamson
- Institute of Infectious Disease and Molecular Medicine and Department of Pathology, University of Cape Town, Cape Town, South Africa; National Health Laboratory Service, Cape Town, South Africa
| | - Maureen Siminya
- Faculty of Health Science Department of Internal Medicine, University of Witwatersrand, Johannesburg, South Africa; Right to Care, Johannesburg, South Africa
| | - Avril Swarts
- Faculty of Health Science Department of Internal Medicine, University of Witwatersrand, Johannesburg, South Africa; Right to Care, Johannesburg, South Africa
| | | | - Qin Liu
- The Wistar Institute , Philadelphia, PA, USA
| | - Cynthia Firnhaber
- Faculty of Health Science Department of Internal Medicine, University of Witwatersrand, Johannesburg, South Africa; Right to Care, Johannesburg, South Africa
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HERD OLIVIA, FRANCIES FLAVIA, KOTZEN JEFFREY, SMITH TRUDY, NXUMALO ZWIDE, MULLER XANTHENE, SLABBERT JACOBUS, VRAL ANNE, BAEYENS ANS. Chromosomal radiosensitivity of human immunodeficiency virus positive/negative cervical cancer patients in South Africa. Mol Med Rep 2016; 13:130-6. [PMID: 26549042 PMCID: PMC4686097 DOI: 10.3892/mmr.2015.4504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 07/28/2015] [Indexed: 12/01/2022] Open
Abstract
Cervical cancer is the second most common cancer amongst South African women and is the leading cause of cancer-associated mortality in this region. Several international studies on radiation‑induced DNA damage in lymphocytes of cervical cancer patients have remained inconclusive. Despite the high incidence of cervical cancer in South Africa, and the extensive use of radiotherapy to treat it, the chromosomal radiosensitivity of South African cervical cancer patients has not been studied to date. Since a high number of these patients are human immunodeficiency virus (HIV)‑positive, the effect of HIV infection on chromosomal radiosensitivity was also investigated. Blood samples from 35 cervical cancer patients (20 HIV‑negative and 15 HIV‑positive) and 20 healthy controls were exposed to X‑rays at doses of 6 MV of 2 and 4 Gy in vitro. Chromosomal radiosensitivity was assessed using the micronucleus (MN) assay. MN scores were obtained using the Metafer 4 platform, an automated microscopic system. Three scoring methods of the MNScore module of Metafer were applied and compared. Cervical cancer patients had higher MN values than healthy controls, with HIV‑positive patients having the highest MN values. Differences between groups were significant when using a scoring method that corrects for false positive and false negative MN. The present study suggested increased chromosomal radiosensitivity in HIV-positive South African cervical cancer patients.
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Affiliation(s)
- OLIVIA HERD
- Department of Radiation Biophysics, NRF-iThemba LABS, Somerset West 7129, South Africa
- Department of Radiation Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
| | - FLAVIA FRANCIES
- Department of Radiation Biophysics, NRF-iThemba LABS, Somerset West 7129, South Africa
- Department of Radiation Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
| | - JEFFREY KOTZEN
- Department of Radiation Oncology, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, South Africa
| | - TRUDY SMITH
- Department of Obstetrics and Gynaecology, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, South Africa
| | - ZWIDE NXUMALO
- Department of Obstetrics and Gynaecology, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, South Africa
| | - XANTHENE MULLER
- Department of Radiation Biophysics, NRF-iThemba LABS, Somerset West 7129, South Africa
| | - JACOBUS SLABBERT
- Department of Radiation Biophysics, NRF-iThemba LABS, Somerset West 7129, South Africa
| | - ANNE VRAL
- Department of Basic Medical Sciences, Ghent University, Ghent B-9000, Belgium
| | - ANS BAEYENS
- Department of Radiation Biophysics, NRF-iThemba LABS, Somerset West 7129, South Africa
- Department of Radiation Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
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39
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Kelly H, Mayaud P, de Sanjose S. Concomitant Infection of HIV and HPV: What Are the Consequences? CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-015-0132-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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40
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Prevalence and predictors of Pap smear cervical epithelial cell abnormality among HIV-positive and negative women attending gynecological examination in cervical cancer screening center at Debre Markos referral hospital, East Gojjam, Northwest Ethiopia. BMC Clin Pathol 2015; 15:16. [PMID: 26401120 PMCID: PMC4579834 DOI: 10.1186/s12907-015-0016-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/08/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cervical cancer is the leading cause of cancer related death among women in developing countries. Cervical cancer is preceded by cervical surface epithelial cell abnormalities (ECA) which can be detected by Pap smear test. Simultaneous human papillomavirus and human immunodeficiency virus (HIV) infection increases cervical cancer. Data on the prevalence and predictors of ECA among women in Ethiopia is limited. Hence, we aimed to determine the prevalence and associated factors of ECA among women. METHODS A comparative cross-sectional study was conducted among HIV+ and HIV- women attending gynecological examination in cervical cancer screening center at the Debre Markos referral hospital. The study subjects were stratified by HIV status and systematic random sampling method was used to recruit study participants. Cervical smears were collected for Pap smear examination. Logistic regression analysis was employed to examine the possible risk factors of cervical ECA. RESULTS A total of 197 HIV+ and 194 HIV- women were enrolled in the study. The overall prevalence of cervical ECA was 14.1 % of which the prevalence of atypical squamous cells undetermined significance (ASCUS), low grade squamous intraepithelial lesion (SIL), high grade SIL, squamous cell carcinoma and ASC, cannot exclude high grade SIL (ASCH) were 5.1, 3.8, 4.1 and 1.0 %, 0.0 % respectively. Significantly higher prevalence of ECA (17.8 %) was observed among HIV+ women (COR 1.9, 95 % CI: 1.1 - 3.4, p = 0.036) as compared to HIV-women (10.3 %). Multiple sexual partnership (AOR 3.2, 95 % CI: 1.1 - 10.0, p = 0.04), early ages of first sexual contact (<15 years) (AOR 5.2, 95 % CI: 1.5 - 17.9, p = 0.009), parity greater than three (AOR 10.9, 95 % CI: 4.2 - 16.8, p < 0.001) and long term oral contraceptive pills (OCP) use (AOR 11.9, 95 % CI: 2.1 - 16.7, p = 0.02) were significant predictors of prevalence of ECA. CONCLUSIONS Cervical ECA is a major problem among HIV-infected women. Lower CD4+ T-cell counts of below 350 cells/μl, HIV infection, multiple sexual partnership, early age at first sexual contact, parity greater than three and long term OCP use were significant predictors of prevalence of ECA. Strengthening screening program in HIV+ women should be considered.
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41
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Lebelo RL, Bogers JJ, Thys S, Depuydt C, Benoy I, Selabe S, Bida MN, Mphahlele M. Detection, genotyping and quantitation of multiple hpv infections in south african women with cervical squamous cell carcinoma. J Med Virol 2015; 87:1594-600. [DOI: 10.1002/jmv.24132] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Ramokone L. Lebelo
- HIV and Hepatitis Research Unit; Department of Virology; University of Limpopo; Medunsa campus/National Health Laboratory Service; Pretoria South Africa
| | - Johannes J. Bogers
- Applied Molecular Biology Research Group; University of Antwerp; Antwerp Belgium
- Department of Molecular Diagnostics; Laboratory for Clinical Pathology AML; Sonic HealthCare Benelux; Antwerp Belgium
| | - Sofie Thys
- Applied Molecular Biology Research Group; University of Antwerp; Antwerp Belgium
- Laboratory for Cell Biology and Histology; University of Antwerp; Antwerp Belgium
| | - Christophe Depuydt
- Department of Molecular Diagnostics; Laboratory for Clinical Pathology AML; Sonic HealthCare Benelux; Antwerp Belgium
| | - Ina Benoy
- Department of Molecular Diagnostics; Laboratory for Clinical Pathology AML; Sonic HealthCare Benelux; Antwerp Belgium
| | - S.Gloria Selabe
- HIV and Hepatitis Research Unit; Department of Virology; University of Limpopo; Medunsa campus/National Health Laboratory Service; Pretoria South Africa
| | - Meshack N. Bida
- Department of Anatomical Pathology; University of Limpopo; Medunsa campus/National Health Laboratory Service; Pretoria South Africa
| | - M.Jeffrey Mphahlele
- HIV and Hepatitis Research Unit; Department of Virology; University of Limpopo; Medunsa campus/National Health Laboratory Service; Pretoria South Africa
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Ogembo RK, Gona PN, Seymour AJ, Park HSM, Bain PA, Maranda L, Ogembo JG. Prevalence of human papillomavirus genotypes among African women with normal cervical cytology and neoplasia: a systematic review and meta-analysis. PLoS One 2015; 10:e0122488. [PMID: 25875167 PMCID: PMC4396854 DOI: 10.1371/journal.pone.0122488] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/22/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several meta-analyses confirmed the five most prevalent human papillomavirus (HPV) strains in women with and without cervical neoplastic diseases are HPV16, 18, 31, 52, and 58. HPV16/18 are the predominant oncogenic genotypes, causing approximately 70% of global cervical cancer cases. The vast majority of the women studied in previous analyses were from Europe, North America, Asia, and most recently Latin America and the Caribbean. Despite the high burden of cervical cancer morbidity and mortality in Africa, a robust meta-analysis of HPV genotype prevalence and distribution in African women is lacking. METHODS AND FINDINGS We systematically searched 14 major databases from inception to August 2013 without language restriction, following the Meta-Analysis of Observational Studies in Epidemiology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventy-one studies from 23 African countries were identified after screening 1162 citations and data abstracted and study quality appraised from 195 articles. HPV type-specific prevalence and distribution was estimated from 17,273 cases of women with normal cervical cytology; 1019 women with atypical squamous cells of undetermined significance (ASCUS); 1444 women with low-grade squamous intraepithelial lesion (LSIL); 1571 women with high-grade squamous intraepithelial lesion (HSIL); and 4,067 cases of invasive cervical carcinoma (ICC). Overall prevalence of HPV16/18 were 4.4% and 2.8% of women with normal cytology, 12.0% and 4.4% with ASCUS, 14.5% and 10.0% with LSIL, 31.2% and 13.9% with HSIL, and 49.7% and 18.0% with ICC, respectively. Study limitations include the lack of adequate data from Middle and Northern African regions, and variations in the HPV type-specific sensitivity of different genotyping protocols. CONCLUSIONS To our knowledge, this study is the most comprehensive assessment of the overall prevalence and distribution of HPV genotypes in African women with and without different cervical neoplasias. We have established that HPV16/18 account for 67.7% of ICC cases among African women. Based on our findings, we highly recommend the administration of existing prophylactic vaccines to younger women not infected with HPV16/18 and an increase in HPV screening efforts for high-risk genotypes to prevent cervical cancer. REVIEW REGISTRATION International Prospective Register of Systematic Reviews CRD42013006558.
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Affiliation(s)
- Rebecca Kemunto Ogembo
- Northeastern University, Boston, MA, United States of America
- University of Massachusetts Medical School, Worcester, MA, United States of America
| | | | | | - Henry Soo-Min Park
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Paul A. Bain
- Countway Library of Harvard Medical School, Boston, MA, United States of America
| | - Louise Maranda
- University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Javier Gordon Ogembo
- University of Massachusetts Medical School, Worcester, MA, United States of America
- * E-mail:
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Schnippel K, Lince-Deroche N, van den Handel T, Molefi S, Bruce S, Firnhaber C. Cost evaluation of reproductive and primary health care mobile service delivery for women in two rural districts in South Africa. PLoS One 2015; 10:e0119236. [PMID: 25751528 PMCID: PMC4353629 DOI: 10.1371/journal.pone.0119236] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 01/28/2015] [Indexed: 01/25/2023] Open
Abstract
Background Cervical cancer screening is a critical health service that is often unavailable to women in under-resourced settings. In order to expand access to this and other reproductive and primary health care services, a South African non-governmental organization established a van-based mobile clinic in two rural districts in South Africa. To inform policy and budgeting, we conducted a cost evaluation of this service delivery model. Methods The evaluation was retrospective (October 2012–September 2013 for one district and April–September 2013 for the second district) and conducted from a provider cost perspective. Services evaluated included cervical cancer screening, HIV counselling and testing, syndromic management of sexually transmitted infections (STIs), breast exams, provision of condoms, contraceptives, and general health education. Fixed costs, including vehicle purchase and conversion, equipment, operating costs and mobile clinic staffing, were collected from program records and public sector pricing information. The number of women accessing different services was multiplied by ingredients-based variable costs, reflecting the consumables required. All costs are reported in 2013 USD. Results Fixed costs accounted for most of the total annual costs of the mobile clinics (85% and 94% for the two districts); the largest contributor to annual fixed costs was staff salaries. Average costs per patient were driven by the total number of patients seen, at $46.09 and $76.03 for the two districts. Variable costs for Pap smears were higher than for other services provided, and some services, such as breast exams and STI and tuberculosis symptoms screening, had no marginal cost. Conclusions Staffing costs are the largest component of providing mobile health services to rural communities. Yet, in remote areas where patient volumes do not exceed nursing staff capacity, incorporating multiple services within a cervical cancer screening program is an approach to potentially expand access to health care without added costs.
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Affiliation(s)
- Kathryn Schnippel
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Naomi Lince-Deroche
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Cynthia Firnhaber
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Right to Care, Johannesburg, South Africa
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44
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Combination antiretroviral therapy reduces the detection risk of cervical human papilloma virus infection in women living with HIV. AIDS 2015; 29:59-66. [PMID: 25387313 DOI: 10.1097/qad.0000000000000512] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Data on the effect of combination antiretroviral therapy (cART) on cervical human papilloma virus (HPV) infection are both limited and conflicting. We aimed to determine the effect of the initiation of cART for HPV genotype detection on cervical samples in HIV-infected South African women. DESIGN Prospective cohort study. METHODS Generalized estimating equation was performed to estimate parameters of mixed-effects logistic regression models of cART on HPV cervical detection risk, adjusting for time-dependent covariates CD4 T-cell count, sexual activity and excision treatment. Ratio of odds ratios (ORs) was computed to compare the pooled cART effect on lower vs. high-risk HPV genotype groups, to the effect of cART on the risk of HPV-16 detection. RESULTS Of the 300 patients, 204 (68%) were commenced on ART during follow-up, as they met the criteria for cART initiation. cART significantly reduced the risk for detection of HPV by 77% [OR 0.23, 95% confidence interval (CI) 0.15-0.37]. cART significantly reduced the risk of HPV-16 detection (OR 0.50, 95% CI 0.37-0.67). Every month on cART significantly reduced the detection risk of any HPV type by 9% (OR 0.91, 95% CI 0.89-0.94). The protective effect of cART on the detection risk for the low-risk HPV genotype group was significantly less than the protective effect of cART on the detection risk of HPV-16 (ratio of ORs 1.35, 95% CI 1.22-1.50). CONCLUSION cART significantly reduced cervical HPV infection. This effect was dependent on the duration of exposure to cART and is the mechanism by which cART may improve the outcome of dysplasia in HIV-infected women.
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Ananworanich J, Prasitsuebsai W, Kerr SJ, Hansudewechakul R, Teeratakulpisarn N, Saisawat K, Ramautarsing R, Achalapong J, Pussadee K, Keadpudsa S, Mackay T, Pankam T, Rodbamrung P, Petdachai W, Chokephaibulkit K, Sohn AH, Phanuphak N. Cervical cytological abnormalities and HPV infection in perinatally HIV-infected adolescents. J Virus Erad 2015; 1:30-37. [PMID: 26005716 PMCID: PMC4439002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Behaviourally HIV-infected adolescent females are at higher risk for abnormal cervical cytology and HPV infection compared to those who are uninfected, but data on perinatally HIV-infected adolescent females are lacking. METHODS Cervical cytology, HPV infection and E6/E7 mRNA were assessed in sexually active 12-24-year-old adolescent females: perinatally HIV-infected (group 1, n = 40), behaviourally HIV-infected (group 2, n = 10), and HIV-uninfected (group 3, n = 10). RESULTS Median age was lower in group 1 (18 years) than in groups 2 (24 years) and 3 (20.5 years) (P < 0.001), and median time since sexual debut was shorter: 2 vs 5 vs 4 years (P < 0.001). More trial participants in group 1 than group 2 were on antiretrovirals (90% vs 70%; P <0.001). Abnormal cervical cytology (atypical squamous cells of undetermined significance and higher) was observed in 30% (group 1), 40% (group 2) and 30% (group 3) (P = 0.92), whereas high-risk HPV infection was observed in 45%, 45% and 40%, respectively (P = 1.00). Positive E6/E7 mRNA was found in 28% of group 1, but not in other groups. High-risk HPV infection predicted abnormal cytology in all groups [OR 6.77, 95% confidence interval (CI) 1.99-23.0; P = 0.001). Additionally, plasma HIV RNA ≥50 copies/mL (OR 13.3, 95% CI 1.16-153.06; P = 0.04) predicted abnormal cytology in HIV-infected adolescent females. CONCLUSIONS Despite the younger age and shorter time since sexual debut, cervical cytological abnormalities and HPV infection were as common in perinatally HIV-infected as in behaviourally infected and uninfected adolescents. HPV vaccination, pre-cancer screening and antiretroviral treatment in HIV-infected female adolescents should be implemented to minimise the risk of cervical cancer.
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Affiliation(s)
- J Ananworanich
- HIV Netherland Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand,,Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand,SEARCH,
The Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand,Corresponding author: Jintanat Ananworanich,
US Military HIV Research Program,
6720A Rockledge Drive, Suite 400,
Rockville,
MD20817,
USA
| | - W Prasitsuebsai
- HIV Netherland Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand,,Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | - S J Kerr
- HIV Netherland Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand,,Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand,Kirby Institute of Infection and Immunity in Society,
University of New South Wales,
Sydney,
Australia
| | | | | | - K Saisawat
- Chiangrai Prachanukroh Hospital,
Chiangrai,
Thailand
| | - R Ramautarsing
- HIV Netherland Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand,,Department of Global Health, Academic Medical Center,
University of Amsterdam, Amsterdam Institute for Global Health and Development (AIGHD),
Amsterdam,
the Netherlands
| | - J Achalapong
- Chiangrai Prachanukroh Hospital,
Chiangrai,
Thailand
| | - K Pussadee
- HIV Netherland Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand,,Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | - S Keadpudsa
- HIV Netherland Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand,,Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | - T Mackay
- HIV Netherland Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand,,Department of Global Health, Academic Medical Center,
University of Amsterdam, Amsterdam Institute for Global Health and Development (AIGHD),
Amsterdam,
the Netherlands
| | - T Pankam
- Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | - P Rodbamrung
- Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | | | - K Chokephaibulkit
- Faculty of Medicine, Siriraj Hosptial,
Mahidol University,
Bangkok,
Thailand
| | - A H Sohn
- TREAT Asia/amfAR – The Foundation for AIDS Research,
Bangkok,
Thailand
| | - N Phanuphak
- Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand,SEARCH,
The Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
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46
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Ananworanich J, Prasitsuebsai W, Kerr S, Hansudewechakul R, Teeratakulpisarn N, Saisawat K, Ramautarsing R, Achalapong J, Pussadee K, Keadpudsa S, Mackay T, Pankam T, Rodbamrung P, Petdachai W, Chokephaibulkit K, Sohn A, Phanuphak N. Cervical cytological abnormalities and HPV infection in perinatally HIV–infected adolescents. J Virus Erad 2015. [DOI: 10.1016/s2055-6640(20)31146-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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47
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Hanisch RA, Cherne SL, Sow PS, Winer RL, Hughes JP, Feng Q, Gottlieb GS, Toure M, Dem A, Kiviat NB, Hawes SE. Human papillomavirus type 16 viral load in relation to HIV infection, cervical neoplasia and cancer in Senegal. Cancer Epidemiol 2014; 38:369-75. [PMID: 24852136 DOI: 10.1016/j.canep.2014.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 04/01/2014] [Accepted: 04/21/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The importance of human papillomavirus (HPV) viral load in the pathogenesis of cervical cancer among HIV-infected and HIV-uninfected women has not yet been established. METHODS In this cross-sectional study, HPV-16 viral loads were measured using previously-collected and frozen cervical swab samples from 498 HPV-16 positive Senegalese women (368 HIV-seronegative, 126 HIV-1 and/or HIV-2 seropositive). The real-time polymerase chain reaction assay was used to quantify HPV-16 E7 copy number normalized by human cellular DNA (β-actin), and viral loads were log10 transformed. Associations between HPV-16 viral load, degree of cervical abnormality, and HIV status were assessed using multinomial and linear regression methods. RESULTS Compared to women with normal cytology, the likelihood of CIN1 (ORa: 1.21, 95% CI 0.93-1.57), CIN2-3 (ORa: 2.38, 95% CI 1.72-3.29) and cancer (ORa: 2.12, 95% CI 1.52-2.96) was found to increase for each 1-unit log10 increase in HPV-16 viral load. Compared to HIV-negative women, HIV-positive women had higher average HPV-16 viral load values (βa: 0.39, 95% CI 0.03-0.75), even after accounting for degree of cervical abnormality. CONCLUSION In our study of women including those with cancer, HPV-16 viral load was associated with a higher likelihood of cervical abnormalities. However, substantial overlaps across categories of disease severity existed. Higher viral load among HIV-infected individuals may indicate that HIV infection influences HPV viral replication factors.
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Affiliation(s)
- Rachel A Hanisch
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA 98195, USA; International Agency for Research on Cancer, Section of Environment and Radiation, 150 Cours Albert Thomas, Lyon Cedex 08 69372, France.
| | - Stephen L Cherne
- Department of Pathology, Harborview Medical Center, Seattle, WA 98104, USA
| | - Papa Salif Sow
- Service des Maladies Infectieuses Ibrahima DIOP MAR - CHU de Fann, Université Cheikh Anta Diop, Dakar, Senegal
| | - Rachel L Winer
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA 98195, USA
| | - James P Hughes
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - Qinghua Feng
- Department of Pathology, Harborview Medical Center, Seattle, WA 98104, USA
| | - Geoffrey S Gottlieb
- Division of Allergy and Infectious Diseases and Department of Global Health, School of Medicine, University of Washington, Seattle, WA 98109, USA
| | - Macoumba Toure
- Service des Maladies Infectieuses Ibrahima DIOP MAR - CHU de Fann, Université Cheikh Anta Diop, Dakar, Senegal
| | - Ahmadou Dem
- Service des Maladies Infectieuses Ibrahima DIOP MAR - CHU de Fann, Université Cheikh Anta Diop, Dakar, Senegal
| | - Nancy B Kiviat
- Department of Pathology, Harborview Medical Center, Seattle, WA 98104, USA
| | - Stephen E Hawes
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA 98195, USA
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Prevalence of premalignant cervical lesions in women with a long-term nonprogressor or HIV controller phenotype. J Acquir Immune Defic Syndr 2014; 65:e29-32. [PMID: 24419070 PMCID: PMC3987062 DOI: 10.1097/qai.0b013e31829ce738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McDonald AC, Tergas AI, Kuhn L, Denny L, Wright TC. Distribution of Human Papillomavirus Genotypes among HIV-Positive and HIV-Negative Women in Cape Town, South Africa. Front Oncol 2014; 4:48. [PMID: 24672770 PMCID: PMC3953716 DOI: 10.3389/fonc.2014.00048] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/27/2014] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE HIV-positive women are known to be at high-risk of human papillomavirus (HPV) infection and its associated cervical pathology. Here, we describe the prevalence and distribution of HPV genotypes among HIV-positive and -negative women in South Africa, with and without cervical intraepithelial neoplasia (CIN). METHODS We report data on 1,371 HIV-positive women and 8,050 HIV-negative women, aged 17-65 years, recruited into three sequential studies in Cape Town, South Africa, conducted among women who had no history of cervical cancer screening recruited from the general population. All women were tested for HIV. Cervical samples were tested for high-risk HPV DNA (Hybrid Capture 2) with positive samples tested to determine the specific genotype (Line Blot). CIN status was determined based on colposcopy and biopsy. RESULTS The HPV prevalence was higher among HIV-positive women (52.4%) than among HIV-negative women (20.8%) overall and in all age groups. Younger women, aged 17-19 years, had the highest HPV prevalence regardless of HIV status. HIV-positive women were more likely to have CIN 2 or 3 than HIV-negative women. HPV 16, 35, and 58 were the most common high-risk HPV types with no major differences in the type distribution by HIV status. HPV 18 was more common in older HIV-positive women (40-65 years) with no or low grade disease, but less common in younger women (17-29 years) with CIN 2 or 3 compared to HIV-negative counterparts (p < 0.03). Infections with multiple high-risk HPV types were more common in HIV-positive than HIV-negative women, controlling for age and cervical disease status. CONCLUSION HIV-positive women were more likely to have high-risk HPV than HIV-negative women; but, among those with HPV, the distribution of HPV types was similar by HIV status. Screening strategies incorporating HPV genotyping and vaccination should be effective in preventing cervical cancer in both HIV-positive and -negative women living in sub-Saharan Africa.
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Affiliation(s)
- Alicia C McDonald
- Department of Population Health, Hofstra North Shore Long Island Jewish School of Medicine , Great Neck, NY , USA ; Feinstein Institute for Medical Research, North Shore Long Island Jewish Health System , Manhasset, NY , USA
| | - Ana I Tergas
- Department of Epidemiology, Mailman School of Public Health, Columbia University , New York, NY , USA ; Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University , New York, NY , USA
| | - Louise Kuhn
- Department of Epidemiology, Mailman School of Public Health, Columbia University , New York, NY , USA ; Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University , New York, NY , USA
| | - Lynette Denny
- Department of Obstetrics and Gynaecology, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town , Cape Town , South Africa
| | - Thomas C Wright
- Department of Pathology, College of Physicians and Surgeons, Columbia University , New York, NY , USA
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50
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Mahomed K, Evans D, Sauls C, Richter K, Smith J, Firnhaber C. Human papillomavirus (HPV) testing on self-collected specimens: perceptions among HIV positive women attending rural and urban clinics in South Africa. Pan Afr Med J 2014; 17:189. [PMID: 25396015 PMCID: PMC4228994 DOI: 10.11604/pamj.2014.17.189.3454] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 11/12/2013] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Cervical cancer is the most common cancer among women in Sub-Saharan Africa. Cervical cancer is treatable if detected timeously, yet only 20% of South African women have ever been for a Pap smear in their lifetime due to limited access to screening, transport or child care responsibilities. OBJECTIVE To evaluate the acceptability of self-collection for cervical cancer screening. We aimed to identify which self-collection device women prefer and if they would consider using them for routine cervical cancer screening. METHODS HIV-positive women (>18 years) from urban and rural HIV clinics were interviewed following an education session on HIV, human papillomavirus (HPV) and cervical cancer. Participants were shown three self-collection devices; (i) an Evalyn cervical brush, (ii) a Delphilavager and (iii) a tampon-like plastic wand before completing a short questionnaire. RESULTS A total of 106 women from the urban (n = 52) and rural (n = 54) clinic were interviewed. Overall 51% of women preferred the cervical brush, while fewer women preferred the tampon-like plastic wand (31%) or lavage sampler (18%). More than 75% of women from the rural site preferred the cervical brush, compared to 22% from the urban site (p < 0.001). Women from the urban clinic preferred the tampon-like plastic wand (45%) and then the lavage sampler (33%), as compared to women from the rural clinic (19% and 4%, respectively). CONCLUSION Women from urban or rural settings had different preferences for the various self-collection devices. Patient self-collection with HPV testing may be an acceptable way to improve coverage to cervical cancer screening in high risk HIV-seropositive women.
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Affiliation(s)
| | - Denise Evans
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Celeste Sauls
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Karin Richter
- Department of Medical Virology, University of Pretoria, National Health Laboratory Service, Pretoria, South Africa
| | - Jennifer Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, United States of America
| | - Cindy Firnhaber
- Right to Care, Johannesburg, South Africa ; Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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