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Gupta R, Hussain S, Hariprasad R, Dhanasekaran K, Verma S, Agarwal V, Sandeep, Parveen S, Kaur A, Verma CP, Amita, Dwivedi R, Singh S, Gupta S. High Prevalence of Cervical High-Grade Lesions and High-Risk Human Papillomavirus Infections in Women Living with HIV: A Case for Prioritizing Cervical Screening in This Vulnerable Group. Acta Cytol 2022; 66:496-506. [PMID: 35760059 DOI: 10.1159/000525340] [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: 01/09/2022] [Accepted: 05/21/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Women living with HIV (WLHIV) are at an increased risk of developing cervical precancerous lesions and cervical human papillomavirus (HPV) infection. This study aimed at evaluating the prevalence of cervical lesions and high-risk HPV (HR-HPV) infection in WLHIV in comparison to the HIV-negative women undergoing opportunistic screening. In addition, these findings among WLHIV were correlated with the clinic-demographic factors. METHODS A cross-sectional study was conducted among WLHIVs at a tertiary hospital and linked antiretroviral therapy (ART) center, while HIV-negative women were recruited from the health promotion clinic at our institute. With informed consent, a semi-structured questionnaire was filled on demographic and epidemiological parameters. Conventional cervical smears and samples for HPV DNA detection by HC2 high-risk HPV DNA test were collected in all participants. Cervical smears were reported using the Bethesda system 2014. Appropriate statistical analysis was performed for bivariate and multivariate logistic regression analysis for comparison between WLHIV and HIV-negative women and for correlation of abnormal cervical cytology and HR-HPV infection among WLHIVs. RESULTS The clinic-demographic characteristics of WLHIVs and HIV-negative women were similar. On cytology, the prevalence of cervical cytological abnormalities were significantly higher (p < 0.001) among WLHIVs (14.1%) compared to HIV-negative women (3.1%). High-grade lesions were seen in 3.7% of WLHIVs, while no high-grade lesions were detected in HIV-negative women. Cervical HR-HPV infection was also significantly higher (p < 0.001) in WLHIVs (28.9%) than HIV-negative women (9.3%). Cervical precancerous lesions in WLHIVs showed positive association with current sexually transmitted infection (STI), multiple sexual partners, tobacco use, and CD4 count less than 200/µL, while cervical HPV was positively associated with current STI, tobacco use, CD4 count less than 200/µL and negatively with ART intake. On multivariate logistic regression, cervical cytological abnormalities showed a significant association with multiple sexual partners (p < 0.001), while cervical HR-HPV infection was positively associated with current STI (p = 0.01), nadir CD4 count <200/µL (p = 0.004), abnormal cervical cytology (p = 0.002) and negatively with ART intake (p = 0.03). CONCLUSION Women living with HIV have a significantly higher prevalence of cervical precancerous lesions and HR-HPV infection compared to the general population. Considering the lack of an organized population-based cervical cancer screening program in many low-resource countries like ours, specific focus on screening this highly vulnerable population to reduce the morbidity and mortality due to cervical cancer is imperative.
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Affiliation(s)
- Ruchika Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Showket Hussain
- Molecular Biology Group, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Roopa Hariprasad
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Kavitha Dhanasekaran
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Sheel Verma
- Medical Officer and Incharge, ART Centre, District Hospital (MMG Hospital), Ghaziabad, India
| | - Vineeta Agarwal
- Department of Gynecology and Obstetrics, Dr Bhim Rao Ambedkar Multispecialty Hospital, Noida, India
| | - Sandeep
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Shahana Parveen
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | | | - Chandresh Pragya Verma
- Division of Preventive Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Amita
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Reena Dwivedi
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Sompal Singh
- Department of Pathology, Hindu Rao Hospital, Delhi, India
| | - Sanjay Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
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Cambrea SC, Aschie M, Resul G, Mitroi AF, Chisoi A, Nicolau AA, Baltatescu GI, Cretu AM, Lupasteanu G, Serbanescu L, Manea M, Topliceanu ST, Petcu LC, Pazara L, Cozaru GC. HPV and HIV Coinfection in Women from a Southeast Region of Romania—PICOPIV Study. Medicina (B Aires) 2022; 58:medicina58060760. [PMID: 35744023 PMCID: PMC9231193 DOI: 10.3390/medicina58060760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022] Open
Abstract
Background and Objectives: Romania faces one of the highest cervical cancer burdens in Europe though it is a preventable cancer through population screening by cytology and human papillomavirus (HPV) detection. Also, it has one of the highest incidences of human immunodeficiency virus (HIV) infection. HPV and HIV coinfection are frequently encountered. The aim of study was to establish the prevalence of HPV infection among HIV-positive women in Southeast Region of Romania, to genotype high risk HPV types -and to correlate the results with clinical data and cytological cervical lesions. Materials and Methods: 40 HIV-positive women were screened for HPV types and for cytological cervical lesions. The findings were evaluated in correlation with CD4 cell counts, HIV viral load, age at first sexual intercourse, number of sexual partners, vaginal candidiasis, and Gardnerella using statistical methods. Results: 19/40 (47.5%) women were positive for HPV types, 63.15% infected with single HPV type and 36.85% with multiple HPV types. The most frequent types were type: 31 (42.1%), 56 (31.57%), 53 (15.78%). On cytology, 34 (85%) women were found with NILM of which 38.23% were HPV-positive. Fifteen percent of women had abnormal cytology (three ASC-US, three LSIL), and all of them were HPV-positive. Through analyzing the value of CD4 count, women with CD4 count ≤ 200 cells/μL were found to be significantly more likely to be infected with HPV; meanwhile there was no correlation between the detection of HPV types and HIV viral load. Candida or Gardnerella were more often associated with HIV-positive women with HPV, than in women without HPV. Conclusions: Infection with HPV types is common among HIV-positive women in the Southeast Region of Romania and it is associated with age at the beginning of sexual life, number of sexual partners, CD4 value, vaginal candidiasis, and Gardnerella infection.
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Affiliation(s)
- Simona Claudia Cambrea
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania; (S.C.C.); (M.A.); (L.S.); (L.P.)
- Clinical Hospital of Infectious Diseases, 100 Ferdinand Blvd., 900178 Constanta, Romania
| | - Mariana Aschie
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania; (S.C.C.); (M.A.); (L.S.); (L.P.)
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Institute of Doctoral Studies, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania
| | - Ghiulendan Resul
- Clinical Hospital of Infectious Diseases, 100 Ferdinand Blvd., 900178 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Institute of Doctoral Studies, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania
- Correspondence: ; Tel.: +40-74-5904-219
| | - Anca Florentina Mitroi
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Sf. Apostol Andrei Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Anca Chisoi
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Sf. Apostol Andrei Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Antonela Anca Nicolau
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Sf. Apostol Andrei Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Gabriela Izabela Baltatescu
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Sf. Apostol Andrei Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Ana Maria Cretu
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Sf. Apostol Andrei Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Gabriela Lupasteanu
- Clinical Hospital of Infectious Disease Sf. Cuvioasa Parascheva, 393 Traian Street, 800179 Galati, Romania;
| | - Lucian Serbanescu
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania; (S.C.C.); (M.A.); (L.S.); (L.P.)
- Sf. Apostol Andrei Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Mihaela Manea
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
| | - Sebastian Theodor Topliceanu
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Institute of Doctoral Studies, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania
| | - Lucian Cristian Petcu
- Faculty of Dentistry, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania;
| | - Loredana Pazara
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania; (S.C.C.); (M.A.); (L.S.); (L.P.)
| | - Georgeta Camelia Cozaru
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, 145 Tomis Blvd., 900591 Constanta, Romania; (A.F.M.); (A.C.); (A.A.N.); (G.I.B.); (A.M.C.); (M.M.); (S.T.T.); (G.C.C.)
- Sf. Apostol Andrei Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
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Castle PE, Einstein MH, Sahasrabuddhe VV. Cervical cancer prevention and control in women living with human immunodeficiency virus. CA Cancer J Clin 2021; 71:505-526. [PMID: 34499351 PMCID: PMC10054840 DOI: 10.3322/caac.21696] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022] Open
Abstract
Despite being highly preventable, cervical cancer is the fourth most common cancer and cause of cancer death in women globally. In low-income countries, cervical cancer is often the leading cause of cancer-related morbidity and mortality. Women living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome are at a particularly high risk of cervical cancer because of an impaired immune response to human papillomavirus, the obligate cause of virtually all cervical cancers. Globally, approximately 1 in 20 cervical cancers is attributable to HIV; in sub-Saharan Africa, approximately 1 in 5 cervical cancers is due to HIV. Here, the authors provide a critical appraisal of the evidence to date on the impact of HIV disease on cervical cancer risk, describe key methodologic issues, and frame the key outstanding research questions, especially as they apply to ongoing global efforts for prevention and control of cervical cancer. Expanded efforts to integrate HIV care with cervical cancer prevention and control, and vice versa, could assist the global effort to eliminate cervical cancer as a public health problem.
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Affiliation(s)
- Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Mark H Einstein
- Department of Obstetrics, Gynecology, and Reproductive Health, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Vikrant V Sahasrabuddhe
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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Zang L, Hu Y. Risk factors associated with HPV persistence after conization in high-grade squamous intraepithelial lesion. Arch Gynecol Obstet 2021; 304:1409-1416. [PMID: 34482445 DOI: 10.1007/s00404-021-06217-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Persistence of HPV infection in patients with high-grade squamous intraepithelial lesion (HSIL) undergoing cervical excision is considered strongly associated with the recurrence and progression of cervical dysplasia. This study aims to review potential risk factors for persistence of HPV infection in patients with HSIL, thus optimizing the postoperative monitoring program and clinical treatment. METHODS Through literature review, published data about estimated prognostic risk factors for persistence of HPV infection in patients with HSIL after conization within two decades were searched and analyzed, and their references were manually reviewed as well. RESULTS Women with persistence of HPV infection after cervical excision were at an extremely high risk of disease recurrence and progression to cervical cancer. Some clinicopathological and even physiological elements involving viral, organic human body and treatment factors, such as human papillomavirus (HPV) 16, high viral load, age older than 50 years and positive surgical margin were of prognostic significance in persistent HPV infection in patients with HSIL, yet some of which still remained controversial. CONCLUSIONS Monitoring prognostic factors in women with persistence of HPV infection who have underwent cervical excision for HSIL are of great significance, especially the follow-up within 2 years postoperatively, which significantly improves the clinical outcome.
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Affiliation(s)
- Lejing Zang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, 325000, Zhejiang Province, China
| | - Yan Hu
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, 325000, Zhejiang Province, China.
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Rositch AF, Levinson K, Suneja G, Monterosso A, Schymura MJ, McNeel TS, Horner MJ, Engels E, Shiels MS. Epidemiology of cervical adenocarcinoma and squamous cell carcinoma among women living with HIV compared to the general population in the United States. Clin Infect Dis 2021; 74:814-820. [PMID: 34143885 PMCID: PMC8906686 DOI: 10.1093/cid/ciab561] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Cervical cancer risk overall is elevated among women living with HIV (WLH). However, it is unclear whether risks of cervical cancer are similarly elevated across histologic subtypes. METHODS Data were utilized from the HIV/AIDS Cancer Match Study, a linkage of 12 US HIV and cancer registries during 1996-2016. Cervical cancers were categorized as adenocarcinoma (AC), squamous cell carcinoma (SCC) or other histologic type. Standardized incidence ratios were estimated to compare rates of AC and SCC in WLH compared to the general population. For WLH, risk factors for AC and SCC were evaluated using Poisson regression. All-cause 5-year survival was estimated by HIV status and histology. RESULTS Overall, 62,615 cervical cancers were identified, including 609 in WLH. Compared to the general population, incidence of AC was 1.47-times higher (95%CI: 1.03-2.05) and incidence of SCC was 3.62-times higher among WLH (95%CI: 3.31-3.94). Among WLH, there was no difference in AC rates by race/ethnicity or HIV transmission group, although SCC rates were lower among White women (vs. Black, adjusted rate ratio (aRR)=0.53; 95%CI: 0.38-0.73) and higher among women who inject drugs (vs. heterosexual transmission; aRR=1.44; 95%CI: 1.17-1.78). Among WLH, 5-year overall survival was similar for AC (46.2%) and SCC (43.8%), but notably lower than women without HIV. CONCLUSIONS Among WLH, AC rates were modestly elevated whereas SCC rates were greatly elevated compared to the general population. These findings suggest that there may be differences in the impact of immunosuppression and HIV status in the development of AC compared to SCC, given their common etiology in HPV infection.
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Affiliation(s)
- Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kimberly Levinson
- Kelly Gynecologic Oncology Service, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Gita Suneja
- Departments of Radiation Oncology and Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Analise Monterosso
- HIV/STD/HCV Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX, USA
| | - Maria J Schymura
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY, USA
| | | | - Marie-Josephe Horner
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Eric Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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CD4 + and CD8 + cell populations in HIV-positive women with cervical squamous intra-epithelial lesions and squamous cell carcinoma. Int J Infect Dis 2020; 103:370-377. [PMID: 33157285 DOI: 10.1016/j.ijid.2020.10.083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION This study aimed to analyse cervical lymphocytic populations in HIV+ and HIV- patients and correlate different cervical lesions with HIV viral load and presence of high-risk HPV types. MATERIAL AND METHODS A total of 132 histological specimens from 40 HIV+ and 72 HIV- patients were evaluated for CD4+ and CD8+ T cell distribution, presence of high-risk HPV types, peripheral blood HIV viral load and CD4+/CD8+ ratio. RESULTS High-grade squamous intraepithelial lesions (HSIL) and squamous cell carcinoma (SCC) from HIV+ patients had lower CD4+ T cell scores compared with HIV- patients. In all lesion groups, HIV+ patients presented higher epithelial and stromal CD8+ T cell scores. HIV viral load was more often detectable in patients with SCC than in those with low-grade squamous intraepithelial lesion (LSIL) (p = 0.0409). HSIL HIV+ patients had lower circulating CD4+ T cell counts (p = 0.0434) and CD4+/CD8+ ratio (p = 0.0378) compared with LSIL HIV+ patients. High-risk HPV types other than 16 and 18/45 were more prevalent in the HIV+ group. DISCUSSION These results support an imbalance between cervical CD4+ and CD8+ T lymphocytes of HIV+ patients with SIL and SCC, with increased CD8+ infiltrate density with lesion severity, even in patients with immune system recovery under cART.
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Reyneke F, Snyman LC, Lawal I, Lengana T, Vorster M, Sathekge M. Diagnostic value of sentinel lymph node scintigraphy and 2-[ 18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in the detection of metastatic lymph nodes in patients with early-stage cervical cancer. World J Nucl Med 2020; 19:240-245. [PMID: 33354179 PMCID: PMC7745871 DOI: 10.4103/wjnm.wjnm_74_19] [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: 10/03/2019] [Accepted: 11/07/2019] [Indexed: 11/04/2022] Open
Abstract
Cervical cancer is staged clinically using the International Federation of Gynaecology and Obstetrics staging system. Although lymph node status does not form part of the staging, it has important prognostic and potential therapeutic implications. The aim of the study was to evaluate the role of sentinel lymph node (SLN) scintigraphy and 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) in detecting lymph node metastases in patients with early-stage cervical cancer. Thirty-six patients with early-stage cervical cancer underwent SLN detection during primary operation. Of the 36 patients, 28 patients underwent 18F-FDG PET/CT before surgery. The 18F-FDG PET/CT images were analyzed with the histopathological findings as the reference standard. The diagnostic performance of 18F-FDG PET/CT in the detection of nodal disease was reported in terms of accuracy value. The SLN detection rate was the highest (91.7%) using the combined method (lymphoscintigraphy, intraoperative gamma probe, and blue dye). Seven of the thirty-six patients had lymph node involvement (19.4%), of which five had preoperative 18F-FDG PET/CT imaging. On overall patient-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of 18F-FDG PET/CT were 40.0%, 78.3%, 28.6%, 85.7%, and 71.4%, respectively. The combination of radiolabeled nanocolloid with blue dye is safe and reliable and allows successful detection of SLNs in patients with early-stage cervical cancer in a population with high prevalence of human immunodeficiency virus. The specificity and NPV of 18F-FDG PET/CT are high and can be used in conjunction with SLN biopsy.
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Affiliation(s)
- Florette Reyneke
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Leon Cornelius Snyman
- Department of Obstetrics and Gynaecology, University of Pretoria and Kalafong Hospital, Pretoria, South Africa
| | - Ismaheel Lawal
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Thabo Lengana
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Mariza Vorster
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
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Lekoane KMB, Kuupiel D, Mashamba-Thompson TP, Ginindza TG. The interplay of HIV and human papillomavirus-related cancers in sub-Saharan Africa: scoping review. Syst Rev 2020; 9:88. [PMID: 32321580 PMCID: PMC7178989 DOI: 10.1186/s13643-020-01354-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 04/08/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND People living with HIV (PLHIV) are at a high risk of developing HPV-related cancers. HPV-related malignancies occur frequently and/or are high among PLHIV, with cervical cancer as a designated AIDS-defining condition. We aimed to explore the evidence on the interplay of HIV and HPV-related cancers in sub-Saharan Africa (SSA). METHODS The scoping review was guided by Arksey and O'Malley's framework. We searched for literature from the following databases: PubMed; World Health Organization (WHO) Library; Science Direct; Google Scholar and EBSCOhost (Academic search complete, Health Source: Nursing/Academic Edition, CINAHL). Studies reporting on evidence HIV and HPV-related cancers interplay in SSA were eligible for inclusion in this review. The Mixed Methods Appraisal Tool (MMAT) tool was used to assess the risk of bias of the included studies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used for reporting the search results. Thematic analysis used to reveal the emerging themes from the included studies. RESULTS A total of 74 potentially eligible articles were screened. Of these, nine (7 reviews, 1 transversal case controls, and 1 quantitative study) were eligible for data extraction. The studies reported about a total of 16,351 participants in different settings. The nine included studies showed evidence of cervical cancer among HIV-infected women and distribution of HPV infection and cervical abnormalities among HIV-positive individuals. In the four studies generalizing about HIV and anal cancer, only one reported about HPV. Two studies generally reported about HIV and head and neck cancers and one reported about interaction of HIV with vaginal cancer, vulvar cancer, and penile cancer, respectively. CONCLUSION HIV positivity is associated with increased prevalence of HPV infection on different anatomic sites, which will result in increased burden of HPV-related cancers among PLHIV. Furthermore, primary studies with robust study designs aimed at investigating the risk developing HPV-related cancers among PLHIV are recommended. Systematic review registration: PROSPERO CRD42017062403.
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Affiliation(s)
- Kabelo Matjie Bridget Lekoane
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Desmond Kuupiel
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa. .,Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Tivani P Mashamba-Thompson
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Themba G Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Todorova A, Schwierzeck V, Turek D, Zink A, Schwerdtfeger C, Kaliebe K, Spinner CD, Traidl-Hoffmann C. Evaluation of anal carcinoma screening in male and female HIV patients at an interdisciplinary HIV therapy centre. J Eur Acad Dermatol Venereol 2019; 33:1595-1601. [PMID: 30883929 DOI: 10.1111/jdv.15575] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/01/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Incidence of anal carcinoma is increased in people living with HIV (PLWH). Due to the improved life expectancy in PLWH, identifying appropriate prevention strategies for non-AIDS-defining cancer types such as anal carcinoma has become a priority in managing PLWH today. OBJECTIVE We aimed to evaluate anal cytology assessment as screening tool for anal dysplasia and/or carcinoma in PLWH, regardless of gender or sexual orientation. Additionally, we investigated the correlation between cancer risk factors and abnormal screening results in our patient cohort. METHODS People living with HIV from the Interdisciplinary HIV Centre of the University Hospital rechts der Isar in Munich, Germany (IZAR), were screened for anal carcinoma by single cytobrush examination and anal Papanicolaou (PAP) smear assessment from 2013 to 2015. Patients with abnormal PAP smear result were offered a follow-up examination after 12 months. Differences between two groups were tested for statistical significance using Student's t-test and Mann-Whitney U-test, as appropriate. RESULTS In total, 101 PLWH were included. 26.7% of subjects (n = 27) were PAP IIID, and 9.9% (n = 10) were PAP IVa. Seven female subjects had an abnormal finding at screening. Smoking was significantly associated with abnormal findings at screening (P = 0.005). In addition, our study found an association between sexually transmitted infections (STI) and anal dysplasia. Condylomata acuminata were increased in subjects with PAP IIID/PAP IVa (P = 0.045). Reactive syphilis serology was found to be significantly associated with abnormal screening results (P = 0.016), respectively. CONCLUSION Our results demonstrate that smoking and two common STIs, condylomata acuminata and syphilis, are risk factors associated with advanced anal intraepithelial neoplasia (AIN) stages in our PLWH cohort. While further analysis is needed to determine diagnostic guidelines concerning AIN in PLWH, these results suggest that interdisciplinary lifestyle prevention strategies are required to reduce the risk factors for AIN in PLWH in an outpatient setting.
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Affiliation(s)
- A Todorova
- Interdisciplinary HIV Center (IZAR), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum Munich - German Research Center for Environmental Health (GmbH), Munich, Germany
| | - V Schwierzeck
- Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum Munich - German Research Center for Environmental Health (GmbH), Munich, Germany
| | - D Turek
- Interdisciplinary HIV Center (IZAR), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum Munich - German Research Center for Environmental Health (GmbH), Munich, Germany
| | - A Zink
- Interdisciplinary HIV Center (IZAR), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Dermatology and Allergy, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - C Schwerdtfeger
- Interdisciplinary HIV Center (IZAR), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Medicine II, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - K Kaliebe
- Interdisciplinary HIV Center (IZAR), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Dermatology and Allergy, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - C D Spinner
- Interdisciplinary HIV Center (IZAR), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Medicine II, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - C Traidl-Hoffmann
- Interdisciplinary HIV Center (IZAR), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum Munich - German Research Center for Environmental Health (GmbH), Munich, Germany
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10
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Pinto LA, Wilkin TJ, Kemp TJ, Abrahamsen M, Isaacs-Soriano K, Pan Y, Webster-Cyriaque J, Palefsky JM, Giuliano AR. Oral and systemic HPV antibody kinetics post-vaccination among HIV-positive and HIV-negative men. Vaccine 2019; 37:2502-2510. [PMID: 30940485 PMCID: PMC6863043 DOI: 10.1016/j.vaccine.2019.03.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/17/2019] [Accepted: 03/18/2019] [Indexed: 12/21/2022]
Abstract
Duration and functional aspects of the oral and systemic antibody responses following HPV vaccination in HIV-negative (HIV-) and HIV-positive (HIV+) men are not well characterized. Oral and systemic HPV-16 and HPV-18-specific antibody levels were evaluated over 18-months of follow-up, in HIV+ and HIV- men. Sera and oral gargles from 147 HIV- men, ages 27-45 and 75 HIV+ men, ages 22-61, who received 3-doses of quadrivalent HPV vaccine were tested for HPV-16 and HPV-18 antibodies at Day 1, Month 7 (1 month post-dose 3), and Month 18 (12 months post-dose 3) and HPV avidity (Day 1, and Month 7) using L1-VLP ELISA. All individuals seroconverted, regardless of HIV-status, following 3-doses of vaccine for HPV-16 and HPV-18. Serum HPV-16 and HPV-18 antibody geometric mean levels were >2-fold lower in HIV+ compared to HIV- men at Month 7 (HPV-16: 808.5 versus 2119.8 EU/mL, and HPV-18: 285.8 versus 611.6 EU/mL, p < 0.001) but not significantly different at Month 18 (HPV-16: 281.8 versus 359.7 EU/mL, p = 0.145, and HPV-18: 120.2 versus 93.4 EU/mL, p = 0.372). Post-vaccination, only oral HPV-16 antibody levels at Month 7 were significantly different between HIV+ and HIV- men (127.7 versus 177.1 EU/mg of IgG, p = 0.008). Among baseline HPV-seronegative men, circulating levels of HPV-16 and HPV-18 antibodies were up to >3 fold lower in HIV+ men, at Months 7 and 18. In contrast, levels of HPV-16 and HPV-18 antibodies after vaccination were not inferior in baseline HPV-seropositive, HIV+ men. HPV-16 and HPV-18 avidity was lower among HIV+ compared to HIV- men at Month 7 (HPV-16: 1.95 M versus 2.12 M, p = 0.027; HPV-18: 1.50 M versus 1.72 M, p < 0.001). Although differences in peak antibody levels were observed between HIV+ and HIV- men following 3 doses of vaccine, plateau antibody levels were overall comparable, and avidity was relatively high for both groups. These data indicate that the vaccine induced antibody affinity maturation in both HIV+ and HIV- men and will likely result in long-term protective immune responses.
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MESH Headings
- Adult
- Alphapapillomavirus/immunology
- Antibodies, Neutralizing/blood
- Antibodies, Viral/blood
- Antibody Affinity
- HIV Infections/complications
- HIV Infections/epidemiology
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18/administration & dosage
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18/immunology
- Human papillomavirus 16/immunology
- Human papillomavirus 18/immunology
- Humans
- Kinetics
- Male
- Middle Aged
- Mouth/immunology
- Papillomavirus Infections/immunology
- Papillomavirus Infections/prevention & control
- Vaccination
- Young Adult
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Affiliation(s)
- Ligia A Pinto
- HPV Immunology and HPV Serology Laboratories, Frederick National Laboratory for Cancer Research, Frederick, MD, United States.
| | - Timothy J Wilkin
- Weill Cornell Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, United States
| | - Troy J Kemp
- HPV Immunology and HPV Serology Laboratories, Frederick National Laboratory for Cancer Research, Frederick, MD, United States
| | - Martha Abrahamsen
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Kimberly Isaacs-Soriano
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Yuanji Pan
- HPV Immunology and HPV Serology Laboratories, Frederick National Laboratory for Cancer Research, Frederick, MD, United States
| | | | | | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
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11
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Guidelines for Cervical Cancer Screening in Immunosuppressed Women Without HIV Infection. J Low Genit Tract Dis 2019; 23:87-101. [DOI: 10.1097/lgt.0000000000000468] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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12
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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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13
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HIV-positive women have higher risk of human papilloma virus infection, precancerous lesions, and cervical cancer. AIDS 2018; 32:795-808. [PMID: 29369827 DOI: 10.1097/qad.0000000000001765] [Citation(s) in RCA: 203] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE HIV-positive women have higher human papillomavirus (HPV) prevalence and cervical cancer incidence than HIV-negative women, partly because of HIV's modifying effect on HPV pathogenesis. We synthesized the literature on the impact of HIV on HPV natural history. DESIGN Systematic review and meta-analysis. METHODS We searched the literature for studies evaluating HPV acquisition and persistence or precancer progression by HIV status. Data on HPV natural history by HIV status, CD4 cell counts, viral load, and antiretroviral therapy (ART) were summarized using fixed effect models. RESULTS Overall, 38 of 1845 abstracts identified met inclusion criteria. HIV-positive women had higher HPV acquisition [relative risk (RRpooled) 2.64, 95% confidence interval (CI) 2.04-3.42] and lower HPV clearance (hazard ratiopooled 0.72, 95% CI 0.62-0.84) than HIV-negative women. HPV acquisition was higher with declining CD4 cell count and was lower in those virally suppressed on ART. HIV was associated with higher incidence of low-grade squamous intraepithelial lesions (LSIL; RRpooled 3.73, 95% CI 2.62-5.32) and high-grade squamous intraepithelial lesions (HSIL; hazard ratiopooled 1.32, 95% CI 1.10-1.58), largely because of increased HPV persistence. ART lowered progression from normal cytology to LSIL (hazard ratiopooled 0.65, 95% CI 0.52-0.82), but not HSIL. Cervical cancer incidence was associated with HIV positivity (RR 4.1, 95% CI 2.3-6.6), but not with ART. CONCLUSION HIV-positive women have higher risk of acquiring HPV, with risk inversely associated with CD4 cell count. ART lowered HPV acquisition, increased clearance, and reduced precancer progression, likely via immune reconstitution. Although some of our results are limited by small number of studies, our study can inform screening guidelines and mathematical modeling for cervical cancer prevention.
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14
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Dryden-Peterson S, Bvochora-Nsingo M, Suneja G, Efstathiou JA, Grover S, Chiyapo S, Ramogola-Masire D, Kebabonye-Pusoentsi M, Clayman R, Mapes AC, Tapela N, Asmelash A, Medhin H, Viswanathan AN, Russell AH, Lin LL, Kayembe MKA, Mmalane M, Randall TC, Chabner B, Lockman S. HIV Infection and Survival Among Women With Cervical Cancer. J Clin Oncol 2017; 34:3749-3757. [PMID: 27573661 DOI: 10.1200/jco.2016.67.9613] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose Cervical cancer is the leading cause of cancer death among the 20 million women with HIV worldwide. We sought to determine whether HIV infection affected survival in women with invasive cervical cancer. Patients and Methods We enrolled sequential patients with cervical cancer in Botswana from 2010 to 2015. Standard treatment included external beam radiation and brachytherapy with concurrent cisplatin chemotherapy. The effect of HIV on survival was estimated by using an inverse probability weighted marginal Cox model. Results A total of 348 women with cervical cancer were enrolled, including 231 (66.4%) with HIV and 96 (27.6%) without HIV. The majority (189 [81.8%]) of women with HIV received antiretroviral therapy before cancer diagnosis. The median CD4 cell count for women with HIV was 397 (interquartile range, 264 to 555). After a median follow-up of 19.7 months, 117 (50.7%) women with HIV and 40 (41.7%) without HIV died. One death was attributed to HIV and the remaining to cancer. Three-year survival for the women with HIV was 35% (95% CI, 27% to 44%) and 48% (95% CI, 35% to 60%) for those without HIV. In an adjusted analysis, HIV infection significantly increased the risk for death among all women (hazard ratio, 1.95; 95% CI, 1.20 to 3.17) and in the subset that received guideline-concordant curative treatment (hazard ratio, 2.63; 95% CI, 1.05 to 6.55). The adverse effect of HIV on survival was greater for women with a more-limited stage cancer ( P = .035), those treated with curative intent ( P = .003), and those with a lower CD4 cell count ( P = .036). Advanced stage and poor treatment completion contributed to high mortality overall. Conclusion In the context of good access to and use of antiretroviral treatment in Botswana, HIV infection significantly decreases cervical cancer survival.
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Affiliation(s)
- Scott Dryden-Peterson
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Memory Bvochora-Nsingo
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Gita Suneja
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Jason A Efstathiou
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Surbhi Grover
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Sebathu Chiyapo
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Doreen Ramogola-Masire
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Malebogo Kebabonye-Pusoentsi
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Rebecca Clayman
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Abigail C Mapes
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Neo Tapela
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Aida Asmelash
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Heluf Medhin
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Akila N Viswanathan
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Anthony H Russell
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Lilie L Lin
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Mukendi K A Kayembe
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Mompati Mmalane
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Thomas C Randall
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Bruce Chabner
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Shahin Lockman
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
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15
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Gallagher KE, Howard N, Kabakama S, Mounier-Jack S, Burchett HED, LaMontagne DS, Watson-Jones D. Human papillomavirus (HPV) vaccine coverage achievements in low and middle-income countries 2007-2016. ACTA ACUST UNITED AC 2017; 4:72-78. [PMID: 29179873 PMCID: PMC5710977 DOI: 10.1016/j.pvr.2017.09.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/22/2017] [Accepted: 09/30/2017] [Indexed: 12/15/2022]
Abstract
Introduction Since 2007, HPV vaccine has been available to low and middle income countries (LAMIC) for small-scale ‘demonstration projects’, or national programmes. We analysed coverage achieved in HPV vaccine demonstration projects and national programmes that had completed at least 6 months of implementation between January 2007–2016. Methods A mapping exercise identified 45 LAMICs with HPV vaccine delivery experience. Estimates of coverage and factors influencing coverage were obtained from 56 key informant interviews, a systematic published literature search of 5 databases that identified 61 relevant full texts and 188 solicited unpublished documents, including coverage surveys. Coverage achievements were analysed descriptively against country or project/programme characteristics. Heterogeneity in data, funder requirements, and project/programme design precluded multivariate analysis. Results Estimates of uptake, schedule completion rates and/or final dose coverage were available from 41 of 45 LAMICs included in the study. Only 17 estimates from 13 countries were from coverage surveys, most were administrative data. Final dose coverage estimates were all over 50% with most between 70% and 90%, and showed no trend over time. The majority of delivery strategies included schools as a vaccination venue. In countries with school enrolment rates below 90%, inclusion of strategies to reach out-of-school girls contributed to obtaining high coverage compared to school-only strategies. There was no correlation between final dose coverage and estimated recurrent financial costs of delivery from cost analyses. Coverage achieved during joint delivery of HPV vaccine combined with another intervention was variable with little/no evaluation of the correlates of success. Conclusions This is the most comprehensive descriptive analysis of HPV vaccine coverage in LAMICs to date. It is possible to deliver HPV vaccine with excellent coverage in LAMICs. Further good quality data are needed from health facility based delivery strategies and national programmes to aid policymakers to effectively and sustainably scale-up HPV vaccination.
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Affiliation(s)
- Katherine E Gallagher
- London School of Hygiene and Tropical Medicine, Clinical Research Department, Keppel St, London WC1E 7HT, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania.
| | - Natasha Howard
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, Keppel St, London WC1E 7HT, United Kingdom
| | - Severin Kabakama
- Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania
| | - Sandra Mounier-Jack
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, Keppel St, London WC1E 7HT, United Kingdom
| | - Helen E D Burchett
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, Keppel St, London WC1E 7HT, United Kingdom
| | - D Scott LaMontagne
- PATH, Center for Vaccine Innovation and Access, PO Box 900922, Seattle, WA 98109, United States
| | - Deborah Watson-Jones
- London School of Hygiene and Tropical Medicine, Clinical Research Department, Keppel St, London WC1E 7HT, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania
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16
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Aserlind A, Maguire K, Duthely L, Wennin S, Potter J. Women Living with HIV over Age of 65: Cervical Cancer Screening in a Unique and Growing Population. Infect Dis Obstet Gynecol 2017; 2017:2105061. [PMID: 29075090 PMCID: PMC5623791 DOI: 10.1155/2017/2105061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/11/2017] [Accepted: 07/30/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Women living with HIV are at increased risk of human papillomavirus (HPV) infection, which can lead to cervical cancer. New guidelines recommend indefinite screening. The objective of this study is to describe cervical cancer screening practices and colposcopy results in a cohort of women living with HIV over age of 65 who were followed before the new guidelines. Comorbidities, sexually transmitted infections (STIs), and other risk factors were evaluated. METHODS We conducted a retrospective chart review on 75 women aged 65 or older living with HIV with at least one Pap smear. RESULTS The mean age of the cohort was 66.5 and at HIV diagnosis was 56. The majority of women were immunocompetent. 80% had serial Pap smears. Of these, 86% of 238 were negative or ASCUS. No women progressed to HSIL. 92% of colposcopies had negative or CIN I results. Three women were treated successfully for high-grade dysplasia. More than half of women had other STIs. 72% were screened for HPV; 50% were positive. CONCLUSION The majority of women had negative and low-grade Pap smears. Questions remain regarding the utility of continued Pap screening and the added value of HPV testing in this unique population of older women living with HIV.
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Affiliation(s)
- Alexandra Aserlind
- University of Miami Miller School of Medicine, Department of Obstetrics & Gynecology, Miami, FL, USA
| | - Karla Maguire
- University of Miami Miller School of Medicine, Department of Obstetrics & Gynecology, Miami, FL, USA
| | - Lunthita Duthely
- University of Miami Miller School of Medicine, Department of Obstetrics & Gynecology, Miami, FL, USA
| | - Stefan Wennin
- University of Miami Miller School of Medicine, Department of Obstetrics & Gynecology, Miami, FL, USA
| | - JoNell Potter
- University of Miami Miller School of Medicine, Department of Obstetrics & Gynecology, Miami, FL, USA
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17
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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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18
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Kingston MA, Bowman CA. The investigation of patients with HIV infection: 10 years of progress. Int J STD AIDS 2017. [DOI: 10.1177/095646240101200101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The past decade has seen great advances in the management of patients with HIV infection. The introduction of highly active antiretroviral therapy (HAART) has resulted in a decrease in opportunistic infections but the development of new clinical entities such as lipodystrophy and immune reconstitution illnesses. The use of investigations such as lipid profiles and dual energy X-ray absorptiometry (DEXA) scanning to assess lipodystrophy have been necessitated by these changes in the epidemic. Technological advances have resulted in new techniques such as viral resistance assays and single photon emission computed tomography (SPECT) scanning. The appropriate use of these investigations is subject to ongoing assessment.
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Affiliation(s)
- M A Kingston
- Department of Genitourinary Medicine, Nottingham City Hospital, Nottingham, UK
| | - C A Bowman
- Department of Genitourinary Medicine, Nottingham City Hospital, Nottingham, UK
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Sansone M, Saccone G, Migliucci A, Saviano R, Capone A, Maruotti GM, Bruzzese D, Martinelli P. Screening for cervical carcinoma in HIV-infected women: Analysis of main risk factors for cervical cytologic abnormalities. J Obstet Gynaecol Res 2016; 43:352-357. [PMID: 28026078 DOI: 10.1111/jog.13225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/11/2016] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to identify potential predictive factors for cervical disease in women with HIV and to evaluate adherence during follow-up to cervical cancer screening. METHODS In order to identify the independent role of factors associated with the presence of a cervical abnormality, all of the variables showing in univariate analyses a potential association with the outcome variable (presence of cervical abnormalities) were entered into a multivariate logistic regression model, along with age at first visit to our center, and age at diagnosis. RESULTS A total of 540 HIV-positive women who received screening for cervical cancer during the first year after their first visit to our center were included in the analysis; 423 (78.3%) had normal cytology and 117 (21.7%) had cytological abnormalities, classified as follows: 21 atypical squamous cells of undetermined significance (17.9%); 51 low-grade squamous intraepithelial lesions (43.6%); 41 high-grade squamous intraepithelial lesions (35.0%); and four cervical cancers (3.4%). In our study, women with more than two previous pregnancies were significantly associated with a lower risk of cervical cytological abnormalities compared to the other women. Women with CD4+ levels of 200-499/mm3 had a higher risk of developing cervical cytological abnormalities compared to those with a CD4+ level > 500/ mm3 . CONCLUSION In summary, management of HIV-positive women must be modeled on HIV-clinical status, CD4+ cell count, drug regimen, and adherence to follow-up, relying on the cooperation of highly qualified professionals. In HIV-positive women, an adequate screening and follow-up allows for a reduced occurrence of advanced cervical disease and prevents recourse to invalidating surgical interventions.
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Affiliation(s)
- Matilde Sansone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Naples, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Naples, Italy
| | - Annalisa Migliucci
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Naples, Italy
| | - Rosa Saviano
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Naples, Italy
| | - Angela Capone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Naples, Italy
| | - Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Naples, Italy
| | - Dario Bruzzese
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Pasquale Martinelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Naples, Italy
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Orang’o EO, Wachira J, Asirwa FC, Busakhala N, Naanyu V, Kisuya J, Otieno G, Keter A, Mwangi A, Inui T. Factors Associated with Uptake of Visual Inspection with Acetic Acid (VIA) for Cervical Cancer Screening in Western Kenya. PLoS One 2016; 11:e0157217. [PMID: 27310005 PMCID: PMC4911084 DOI: 10.1371/journal.pone.0157217] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/26/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Cervical cancer screening has been successful in reducing the rates of cervical cancer in developed countries, but this disease remains the leading cause of cancer deaths among women in sub-Saharan Africa. We sought to understand factors associated with limited uptake of screening services in our cervical cancer-screening program in Western Kenya. PARTICIPANTS AND METHODS Using items from a previously validated cancer awareness questionnaire repurposed for use in cervical cancer and culturally adapted for use in Kenya, we interviewed 2,505 women aged 18-55 years receiving care in gynecology clinics or seeking other services in 4 health facilities in Western Kenya between April 2014 and September 2014. We used logistic regression modeling to assess factors associated with uptake (or non-uptake), associated odds ratios (ORs) and the 95% confidence intervals (95% CI). RESULTS Only two hundred and seventy-three women out of 2505 (11%) accepted VIA cervical cancer screening. Knowledge of just how women are screened for cervical cancer was significantly associated with reduced uptake of cervical cancer screening (OR: 0.53; CI 0.38-0.73) as was fear that screening would reveal a cancer (OR 0.70; CI 0.63-0.77), and reliance on prayer with the onset of illness (OR 0.43; CI 0.26-0.71). Participants who thought that one should get cervical cancer screening even if there were no symptoms were more than twice as likely to accept cervical cancer screening (OR 2.21; 95% CI 1.24-3.93). Older patients, patients living with HIV and women who do not know if bleeding immediately after sex might be a sign of cervical cancer were also more likely to accept screening (OR 1.03, CI 1.02-1.04; OR 1.78, CI 1.01-3.14; OR 2.39, CI 1.31-4.39, respectively). CONCLUSIONS In our population, a high percent of women knew that it is appropriate for all women to get cervical cancer screening, but only a small proportion of women actually got screening. There may be an opportunity to design educational materials for this population that will not only encourage participation in cervical cancer screening but also remediate misconceptions. The discussion illustrates how our findings could be used in such an effort.
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Affiliation(s)
- Elkanah Omenge Orang’o
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Reproductive Health, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Juddy Wachira
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Fredrick Chite Asirwa
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, United States of America
- Regenstrief Institute, Inc. Indianapolis, United States of America
| | - Naftali Busakhala
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Pharmacology/Oncology, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Violet Naanyu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Job Kisuya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Grieven Otieno
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Alfred Keter
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ann Mwangi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Thomas Inui
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, United States of America
- Regenstrief Institute, Inc. Indianapolis, United States of America
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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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Silva LD, Miranda A, Batalha R, Ferreira L, Santos M, Talhari S. High-risk human papillomavirus and cervical lesions among women living with HIV/AIDS in Brazilian Amazon, Brazil. Braz J Infect Dis 2015; 19:557-62. [PMID: 26260194 PMCID: PMC9425384 DOI: 10.1016/j.bjid.2015.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 07/06/2015] [Accepted: 07/06/2015] [Indexed: 02/07/2023] Open
Abstract
Objective The goal of this study was to determine the prevalence of human papillomavirus infection infection and cervical lesions and its associated factors among HIV infected women attending an AIDS clinic in Amazonas state, Brazil. Methods Cross-sectional study. Women attending an AIDS clinic in the city of Manaus between March and December 2011 for gynecological examination were invited to participate. Enrolled patients answered a standardized interview including demographical, behavioral, and clinical data. Additionally, patients underwent a gynecological evaluation with collection of cervical samples for cytological analysis and high-risk human papillomavirus infection hybrid capture. A blood sample was also obtained to determine CD4 and viral load levels. Results A total of 310 (82.9%) women participated in the study. High-risk human papillomavirus infection was detected in 191 (61.6%) cases; 24 (13.5%) had low-grade squamous intraepithelial lesion (SIL) and 4 (2.2%) high-grade SIL. No invasive cervical cancer was diagnosed. Median age was 32 (interquartile range (IQR): 27–38) years and median of education was 8.5 (IQR 4–11) years of schooling and 56.1% had a monthly income up to US$180. In multivariate analysis, being less than 30 years old [OR = 1.7 (95% CI: 1.2–2.4, p = 0.005)], high-grade SIL [OR = 6.5 (95% CI: 1.6–23.0, p = 0.009)], and CD4 counts <200 cells/mm3 [OR = 1.6 (95% CI: 1.2–2.0, p < 0.001)] were associated with high risk human papillomavirus infection infection. Conclusions In the present study high-risk human papillomavirus infection was frequent and it was associated to high-SIL. These results show the importance of gynecologic examinations in routine care and follow-up required by those who present with cervical lesions.
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Affiliation(s)
- Leila da Silva
- Fundação de Vigilância em Saúde do Amazonas, Manaus, AM, Brazil; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil; Faculdade de Medicina, Universidade Nilton Lins, Manaus, AM, Brazil.
| | - Angélica Miranda
- Post Graduation Program in Tropical Medicine, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado/ Universidade do Estado do Amazonas, Manaus, AM, Brazil; Infectious Diseases Unit, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | - Rosieny Batalha
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Luiz Ferreira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil; Post Graduation Program in Tropical Medicine, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado/ Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Mayara Santos
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Sinésio Talhari
- Post Graduation Program in Tropical Medicine, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado/ Universidade do Estado do Amazonas, Manaus, AM, Brazil
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Royse KE, Zhi D, Conner MG, Clodfelder-Miller B, Srinivasasainagendra V, Vaughan LK, Skibola CF, Crossman DK, Levy S, Shrestha S. Differential Gene Expression Landscape of Co-Existing Cervical Pre-Cancer Lesions Using RNA-seq. Front Oncol 2014; 4:339. [PMID: 25505737 PMCID: PMC4244708 DOI: 10.3389/fonc.2014.00339] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 11/11/2014] [Indexed: 01/08/2023] Open
Abstract
Genetic changes occurring in different stages of pre-cancer lesions reflect causal events initiating and promoting the progression to cancer. Co-existing pre-cancerous lesions including low- and high-grade squamous intraepithelial lesion (LGSIL and HGSIL), and adjacent “normal” cervical epithelium from six formalin-fixed paraffin-embedded samples were selected. Tissues from these 18 samples were isolated using laser-capture microdissection, RNA was extracted and sequenced. RNA-sequencing generated 2.4 billion raw reads in 18 samples, of which ~50.1% mapped to known and annotated genes in the human genome. There were 40 genes up-regulated and 3 down-regulated (normal to LGSIL) in at least one-third of the sample pairs (same direction and FDR p < 0.05) including S100A7 and KLK6. Previous studies have shown that S110A7 and KLK7 are up-regulated in several other cancers, whereas CCL18, CFTR, and SLC6A14, also differentially expressed in two samples, are up-regulated specifically in cervical cancer. These differentially expressed genes in normal to LGSIL progression were enriched in pathways related to epithelial cell differentiation, keratinocyte differentiation, peptidase, and extracellular activities. In progression from LGSIL to HGSIL, two genes were up-regulated and five down-regulated in at least two samples. Further investigations using co-existing samples, which account for all internal confounders, will provide insights to better understand progression of cervical pre-cancer.
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Affiliation(s)
- Kathryn E Royse
- Department of Epidemiology, University of Alabama at Birmingham , Birmingham, AL , USA
| | - Degui Zhi
- Department of Biostatistics, University of Alabama at Birmingham , Birmingham, AL , USA
| | - Michael G Conner
- Department of Pathology, University of Alabama at Birmingham , Birmingham, AL , USA
| | - Buffie Clodfelder-Miller
- Cellular and Molecular Neuropathology Core, University of Alabama at Birmingham , Birmingham, AL , USA
| | | | - Laura Kelly Vaughan
- Department of Biostatistics, University of Alabama at Birmingham , Birmingham, AL , USA
| | - Christine F Skibola
- Department of Epidemiology, University of Alabama at Birmingham , Birmingham, AL , USA
| | - David K Crossman
- Department of Genetics, University of Alabama at Birmingham , Birmingham, AL , USA
| | - Shawn Levy
- Hudson Alpha Institute for Biotechnology , Huntsville, AL , USA
| | - Sadeep Shrestha
- Department of Epidemiology, University of Alabama at Birmingham , Birmingham, AL , USA
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Mbulawa ZZA, Johnson LF, Marais DJ, Gustavsson I, Moodley JR, Coetzee D, Gyllensten U, Williamson AL. Increased alpha-9 human papillomavirus species viral load in human immunodeficiency virus positive women. BMC Infect Dis 2014; 14:51. [PMID: 24484380 PMCID: PMC3922074 DOI: 10.1186/1471-2334-14-51] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 01/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persistent high-risk (HR) human papillomavirus (HPV) infection and increased HR-HPV viral load are associated with the development of cancer. This study investigated the effect of human immunodeficiency virus (HIV) co-infection, HIV viral load and CD4 count on the HR-HPV viral load; and also investigated the predictors of cervical abnormalities. METHODS Participants were 292 HIV-negative and 258 HIV-positive women. HR-HPV viral loads in cervical cells were determined by the real-time polymerase chain reaction. RESULTS HIV-positive women had a significantly higher viral load for combined alpha-9 HPV species compared to HIV-negative women (median 3.9 copies per cell compared to 0.63 copies per cell, P = 0.022). This was not observed for individual HPV types. HIV-positive women with CD4 counts >350/μl had significantly lower viral loads for alpha-7 HPV species (median 0.12 copies per cell) than HIV-positive women with CD4 ≤350/μl (median 1.52 copies per cell, P = 0.008), but low CD4 count was not significantly associated with increased viral load for other HPV species. High viral loads for alpha-6, alpha-7 and alpha-9 HPV species were significant predictors of abnormal cytology in women. CONCLUSION HIV co-infection significantly increased the combined alpha-9 HPV viral load in women but not viral loads for individual HPV types. High HR-HPV viral load was associated with cervical abnormal cytology.
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Affiliation(s)
| | | | | | | | | | | | | | - Anna-Lise Williamson
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, 7925 Cape Town, South Africa.
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Effect of highly active antiretroviral therapy (HAART) and menopause on risk of progression of cervical dysplasia in human immune-deficiency virus- (HIV-) infected women. Infect Dis Obstet Gynecol 2013; 2013:784718. [PMID: 24453469 PMCID: PMC3878554 DOI: 10.1155/2013/784718] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/30/2013] [Accepted: 11/03/2013] [Indexed: 02/03/2023] Open
Abstract
Background. More HIV-infected women are reaching older age and menopause, but there is limited information on cervical squamous intraepithelial lesions (SILs) on these women. Methods. To assess the effect of HAART and menopause on SILs in HIV-infected women, we reviewed the results of Papanicolaou (Pap) tests obtained between 1991 and 2011 on 245 women. Progression to SILs was determined by comparing Pap test results. The association of HAART and transition to menopause on SILs was assessed using survival analysis. Results. Women receiving HAART had a 52% reduced risk in the progression to SILs compared to women receiving any other antiretroviral regimen or no regimen (CI: 0.33–0.70, P = 0.0001). A greater increase of CD4+ cell counts was associated with a greater reduction on the risk of progression to SILs. Menopausal women had a 70% higher risk of progression to SILs than premenopausal women (CI: 1.11–2.62, P < 0.0001), adjusting for HIV medications, CD4+ count, duration of HIV infection, moderation effect of menopause by age, prior IV drug use, and smoking. Conclusion. HAART had a positive long-term effect on the progression to SILs. However, being younger and menopausal increases the risk of progression.
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Hanisch RA, Sow PS, Toure M, Dem A, Dembele B, Toure P, Winer RL, Hughes JP, Gottlieb GS, Feng Q, Kiviat NB, Hawes SE. Influence of HIV-1 and/or HIV-2 infection and CD4 count on cervical HPV DNA detection in women from Senegal, West Africa. J Clin Virol 2013; 58:696-702. [PMID: 24210330 DOI: 10.1016/j.jcv.2013.10.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 09/16/2013] [Accepted: 10/09/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND HIV infection is associated with greater risk of precancerous lesions and cervical cancer in women. However, several factors remain unclarified regarding the association between HIV infection and HPV detection, especially among those with HIV type 2 versus type 1 infection and severely immunocompromised persons. OBJECTIVES To evaluate HPV overall and type-specific detection among HIV-infected and uninfected women in Senegal. STUDY DESIGN Detection of HPV DNA for 38 genotypes in cervical swabs using PCR-based methods was evaluated in HIV-positive (n=467) and HIV-negative (n=2139) women participating in studies in Senegal. Among HIV-1 and/or HIV-2 positive women, CD4 counts were assessed. Adjusted multivariable prevalence ratios (PR) were calculated. RESULTS The prevalence of any HPV DNA and multiple HPV types was greater among HIV-infected individuals (78.2% and 62.3%, respectively) compared with HIV-negative women (27.1% and 11.6%). This trend was also seen for HPV types 16 and 18 (13.1% and 10.9%) compared to HIV-negative women (2.2% and 1.7%). HIV-infected women with CD4 cell counts less than 200 cells/μl had a higher likelihood of any HPV detection (PRa 1.30; 95% CI 1.07-1.59), multiple HPV types (PRa 1.52; 95% CI 1.14-2.01), and HPV-16 (PRa 9.00; 95% CI 1.66-48.67), but not HPV-18 (PRa 1.20, 95% CI 0.45-3.24) compared to those with CD4 counts 500 cells/μl or above. CONCLUSION HIV-infected women, especially those most severely immunocompromised, are more likely to harbor HPV. Measures to prevent initial HPV infection and subsequent development of cervical cancer through focused screening efforts should be implemented in these high risk populations.
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Affiliation(s)
- R 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, 69372 Cedex 08, France.
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Denslow SA, Rositch AF, Firnhaber C, Ting J, Smith JS. Incidence and progression of cervical lesions in women with HIV: a systematic global review. Int J STD AIDS 2013; 25:163-77. [PMID: 24216030 DOI: 10.1177/0956462413491735] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Global data on cervical lesion incidence and progression in HIV-positive women are essential for understanding the natural history of cervical neoplasia and informing screening policy. A systematic review was performed summarizing the incidence and progression of cervical lesions in HIV-positive women. Of 5882 HIV-positive women from 15 studies, incidence ranged from 4.9 to 21.1 cases per 100 woman-years for any cervical lesion and 0.4 to 8.8 cases per 100 woman-years for high-grade cervical lesions. HIV-positive women showed a median three-fold higher incidence of cervical lesions compared to HIV-negative women. Of 1099 HIV-positive women from 11 studies, progression from low- to high-grade lesions ranged from 1.2 to 26.2 cases per 100 woman-years. Both incidence and progression rates increased with lower CD4 counts. The effect of antiretroviral therapy on the natural history of cervical neoplasia remains unclear. HIV-positive women have higher incidence and progression of cervical neoplasia. Cervical cancer screening should be integrated into HIV treatment programmes.
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Affiliation(s)
- Sheri A Denslow
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
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Squamous intraepithelial lesions in HIV-infected women: prevalence, incidence, progression and regression. Arch Gynecol Obstet 2013; 288:1107-13. [DOI: 10.1007/s00404-013-2871-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 04/25/2013] [Indexed: 11/25/2022]
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Progression and Persistence of Low-Grade Cervical Squamous Intraepithelial Lesions in Women Living With Human Immunodeficiency Virus. J Low Genit Tract Dis 2012; 16:243-50. [DOI: 10.1097/lgt.0b013e3182403d18] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Firnhaber C, Westreich D, Schulze D, Williams S, Siminya M, Michelow P, Levin S, Faesen M, Smith JS. Highly active antiretroviral therapy and cervical dysplasia in HIV-positive women in South Africa. J Int AIDS Soc 2012; 15:17382. [PMID: 22713259 PMCID: PMC3499783 DOI: 10.7448/ias.15.2.17382] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 01/15/2012] [Accepted: 02/27/2012] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The risk of squamous intra-epithelial lesions (SIL) is higher in HIV-positive women. As these women begin to live longer due to highly active antiretroviral therapy (HAART), their risk of cervical cancer may increase. Few data exist regarding the effect of HAART on the incidence and progression of SIL in HIV-positive African women. The aim of this study was to evaluate the effect of HAART on the incidence and progression of SIL in HIV-positive women in South Africa. METHODS A prospective observational study of HIV-seropositive women was conducted over 5 years in an HIV treatment clinic in Johannesburg, South Africa. The participants consisted of 601 women on and off HAART who had repeat Pap smears greater than 6 months apart. The effect of HAART use on incidence and progression rates of SIL was determined using multivariate Poisson regression to obtain incidence rate ratios (IRRs), adjusted for age, CD4 count and other potential confounders. RESULTS Median follow-up time was 445 days (inter-quartile range 383, 671). The crude rate of incidence of any SIL was 15.9 episodes (95% confidence limit (CL) 12.7, 19.9) per 100 person-years; the crude rate of all progression of cervical dysplasia among women was 13.5 episodes (95% CL 11.3, 16.1) per 100 person-years. HAART use was associated with a robust reduction in the rate of incidence and progression of cervical lesions, adjusted IRR=0.55 (95% CL 0.37, 0.80). Sensitivity analyses confirmed this main association held for incidence and progression when they were considered separately, and that the result was not dependent on the length of HAART exposure. CONCLUSION HAART use was associated with a reduction in the rate of both incidence and progression of cervical lesions among HIV-positive women.
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Affiliation(s)
- Cynthia Firnhaber
- Faculty of Health Science Center, Department of Medicine, Clinical HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa.
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Araújo ACL, Carvalho NO, Teixeira NC, Souza TT, Murta ED, Faria IM, Corrêa CM, Lima MIM, Del Castillo DM, Melo VH. Incidence of cervical intraepithelial neoplasia in a cohort of HIV-infected women. Int J Gynaecol Obstet 2012; 117:211-6. [PMID: 22445392 DOI: 10.1016/j.ijgo.2011.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 12/20/2011] [Accepted: 02/22/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess cervical intraepithelial neoplasia (CIN) incidence in HIV-positive women and the risk factors for these lesions. METHODS A retrospective and longitudinal cohort study was conducted from June 13, 1997, to December 18, 2009. At the first visit, the 348 participants had a normal cytologic finding but a negative Schiller test result, or an abnormal cytologic finding but no histologic diagnosis of CIN. Infection with HPV was detected by polymerase chain reaction. The main outcome measure was CIN incidence. RESULTS During a mean follow-up of 40 months, 47 women (13.5%) developed CIN, for an incidence of 4.1 cases per 100 person-years of follow-up. The HPV prevalence was 68.1%, 42 women (89.4%) developed CIN 1, and no invasive cervical cancers were identified. On multivariate analysis, women younger than 19 years at first sexual intercourse (RR, 2.6; 95% CI, 1.24-5.35) and women who had never used antiretrovirals or used them only during pregnancy (RR, 2.3; 95% CI, 1.31-4.19) were at higher risk for CIN. CONCLUSION The CIN incidence was low despite the high HPV prevalence. Being younger than 19 years at first sexual intercourse and not using antiretroviral medications were found to be the main risk factors for CIN.
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Setse R, Siberry GK, Moss WJ, Gravitt P, Wheeling T, Bohannon B, Dominguez K. Cervical pap screening cytological abnormalities among HIV-infected adolescents in the LEGACY cohort. J Pediatr Adolesc Gynecol 2012; 25:27-34. [PMID: 22088311 PMCID: PMC4152823 DOI: 10.1016/j.jpag.2011.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 09/02/2011] [Accepted: 09/10/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine the prevalence of cervical Pap screening (CPAP-S), identify factors associated with CPAP-S, and explore risk factors for abnormal cervical cytology in female adolescents with perinatally and behaviorally acquired HIV infection. DESIGN Cross-sectional. SETTING LEGACY is a national observational cohort chart review study of 1478 HIV-infected persons (<age 24 years) managed in 22 HIV specialty clinics in the United States. PARTICIPANTS Sexually active females aged 13-24 years in the LEGACY cohort. MAIN OUTCOME MEASURES CPAP-S and abnormal cervical cytology. RESULTS Of 231 sexually active female LEGACY participants 13-24 years of age 49% had documentation of CPAP-S between 2001 and 2006. Fifty-eight percent of 113 cervical tests were abnormal (2% high-grade). In multivariable analysis, perinatal HIV infection and black race were associated with decreased likelihood of CPAP-S (adjusted prevalence ratio [APR] 0.66, 95% CI 0.45-0.96 and APR 0.74, 95% CI 0.56-0.96, respectively). Presence of any sexually transmitted infection (STI) was independently associated with increased likelihood of CPAP-S (APR 1.56, 95% CI 1.21, 2.02). CD4+ T-lymphocyte count <200 cells/mL and previous STI diagnosis were independently associated with increased likelihood of abnormal cervical cytology (APR 2.19, 95% CI 1.26-3.78 and APR 1.94, 95% CI 1.29-2.92, respectively). CONCLUSIONS Among sexually active HIV-infected adolescent females, prevalence of CPAP-S was low and cytology was abnormal in more than half of Pap smears. Perinatally HIV-infected, sexually active females were less likely to undergo CPAP-S than their behaviorally HIV-infected counterparts. Interventions targeted at HIV-infected adolescents and care providers are needed to improve CPAP-S in HIV-infected young women, especially those with perinatally acquired HIV infection.
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Affiliation(s)
- Rosanna Setse
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Pinto VM, Golub JE, Tancredi MV, Alencar RS, Miranda AE. Cervical cytology and histopathologic abnormalities in women living with AIDS in São Paulo, Brazil. J Acquir Immune Defic Syndr 2011; 57 Suppl 3:S212-6. [PMID: 21857321 PMCID: PMC6203957 DOI: 10.1097/qai.0b013e31821e996e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women living with HIV/AIDS present with a higher prevalence of human papillomavirus (HPV) infection, higher rates of squamous intraepithelial lesions, and are more susceptible to invasive cervical carcinoma progression. OBJECTIVE We assessed the frequency of precursory cervical lesions of cancer and its risk factors for women living with HIV/AIDS. METHODS Sociodemographic, clinical, behavioral, and laboratory data were collected from medical records from 2008 to 2009 and analyzed using forward stepwise logistic regression. RESULTS Medical records of 631 women were reviewed; mean age at AIDS diagnosis was 34 years old (interquartile range = 29-40 years old), 32% were <16 years old at first sexual intercourse; 61% had ≤5 sexual partners during life; 43% had been living with AIDS for ≥9 years; 47% reported previous sexually transmitted infections; 44% presented with HPV infection; and 10% presented with high squamous intraepithelial lesions. Presenting high squamous intraepithelial lesions was significantly associated with home district Human Development Index, age at AIDS diagnosis (>40 years old), time of AIDS diagnosis (>8 years), CD4 cell count <350/mm, and HPV infection. CONCLUSIONS Frequent squamous intraepithelial neoplasia in these women shows the importance of gynecologic examinations in routine care and follow-up required by those who present with cervical lesions.
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Affiliation(s)
- Valdir Monteiro Pinto
- Departamento de DST, AIDS e Hepatites virais, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brazil. ;
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Adler DH. The impact of HAART on HPV-related cervical disease. Curr HIV Res 2011; 8:493-7. [PMID: 20946095 DOI: 10.2174/157016210793499240] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 10/24/2010] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW highly active antiretroviral therapy (HAART) has had an unequivocally positive impact on morbidity and mortality in HIV-infected individuals. These benefits have clearly extended to some HIV-related malignancies, including Kaposi's sarcoma and non-Hodgkin's lymphoma. The impact of HAART on cervical cancer, however, remains uncertain. The objective of this review is to summarize the last ten years of registry-based and clinical research into the impact of HAART on human papillomavirus (HPV) related cervical disease. RELEVANT FINDINGS compared to their HIV-uninfected counterparts, HIV-infected women have an increased prevalence of HPV infection, increased risk of progression of HPV-related cervical disease, and an increased risk of invasive cervical cancer. While the partial immune reconstitution afforded by HAART might be expected to decrease susceptibility to HPV infection and cervical disease, the local effects of improved immunosurveillance on the cervix are uncertain and the increased longevity of patients on HAART may increase risk of exposure to HPV and provide the time required for progression of cervical disease. Registry-based evidence has been consistent in identifying the lack of decrease in cervical cancer incidence in the HAART era. Clinical research on the subject, however, has produced conflicting evidence with regards to both the effect of HAART on HPV infection and its impact on cervical disease progression/regression. SUMMARY the incidence of cervical cancer has not decreased in the HAART-era. Furthermore, clinical research has not shown a clear benefit of HAART in decreasing HPV-related cervical disease in HIV-infected women. A better understanding of this subject will have an impact on cervical disease surveillance practices.
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Affiliation(s)
- David H Adler
- University of Rochester, 601 Elmwood Avenue, Box 655, Rochester, NY 14642, USA.
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Denslow SA, Westreich DJ, Firnhaber C, Michelow P, Williams S, Smith JS. Bacterial vaginosis as a risk factor for high-grade cervical lesions and cancer in HIV-seropositive women. Int J Gynaecol Obstet 2011; 114:273-7. [PMID: 21683359 DOI: 10.1016/j.ijgo.2011.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 03/24/2011] [Accepted: 05/17/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the effect of bacterial vaginosis (BV) on the risk of high-grade squamous intraepithelial lesions (HSIL) among HIV-seropositive women. METHODS A hospital-based prospective cohort study of HIV-seropositive women was conducted in Johannesburg, South Africa from January 2005 to September 2009. Multivariate log-binomial and Poisson regressions were used to estimate prevalence and rate ratios, respectively. RESULTS Among 1954 HIV-seropositive women, the baseline prevalence of HSIL was 17%. BV prevalence was high (54%) and showed no association with prevalence of HSIL (adjusted prevalence ratio, 1.12; 95% confidence intervals (CI), 0.92-1.35) nor with cervical lesion progression at follow-up visit (n=503) (adjusted rate ratio: 1.00; 95% CI, 0.65-1.53). CONCLUSION Among HIV-seropositive women, BV was not associated with an increased risk of HSIL or cervical lesion progression.
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Affiliation(s)
- Sheri A Denslow
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
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Pantanowitz L, Michelow P. Review of Human Immunodeficiency Virus (HIV) and squamous lesions of the uterine cervix. Diagn Cytopathol 2010; 39:65-72. [DOI: 10.1002/dc.21364] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Parham GP, Mwanahamuntu MH, Sahasrabuddhe VV, Westfall AO, King KE, Chibwesha C, Pfaendler KS, Mkumba G, Mudenda V, Kapambwe S, Vermund SH, Hicks ML, Stringer JS, Chi BH. Implementation of cervical cancer prevention services for HIV-infected women in Zambia: measuring program effectiveness. ACTA ACUST UNITED AC 2010; 4:703-722. [PMID: 25419240 DOI: 10.2217/hiv.10.52] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cervical cancer kills more women in low-income nations than any other malignancy. A variety of research and demonstration efforts have proven the efficacy and effectiveness of low-cost cervical cancer prevention methods but none in routine program implementation settings of the developing world, particularly in HIV-infected women. METHODS In our public sector cervical cancer prevention program in Zambia, nurses conduct screening using visual inspection with acetic acid aided by digital cervicography. Women with visible lesions are offered same-visit cryotherapy or referred for histologic evaluation and clinical management. We analyzed clinical outcomes and modeled program effectiveness among HIV-infected women by estimating the total number of cervical cancer deaths prevented through screening and treatment. RESULTS Between 2006 and 2008, 6572 HIV-infected women were screened, 53.6% (3523) had visible lesions, 58.5% (2062) were eligible for cryotherapy and 41.5% (1461) were referred for histologic evaluation. A total of 75% (1095 out of 1462) of patients who were referred for evaluation complied. Pathology results from 65% (715 out of 1095) of women revealed benign abnormalities in 21% (151), cervical intraepithelial neoplasia (CIN) I in 30% (214), CIN 2/3 in 33% (235) and invasive cervical cancer in 16.1% (115, of which 69% were early stage). Using a conditional probability model, we estimated that our program prevented 142 cervical cancer deaths (high/low range: 238-96) among the 6572 HIV-infected women screened, or one cervical cancer death prevented per 46 (corresponding range: 28-68) HIV-infected women screened. CONCLUSION Our prevention efforts using setting-appropriate human resources and technology have reduced morbidity and mortality from cervical cancer among HIV-infected women in Zambia. Financial support for implementing cervical cancer prevention programs integrated within HIV/AIDS care programs is warranted. Our prevention model can serve as the implementation platform for future low-cost HPV-based screening methods, and our results may provide the basis for comparison of programmatic effectiveness of future prevention efforts.
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Affiliation(s)
- Groesbeck P Parham
- University of Alabama at Birmingham, AL, USA ; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia ; University Teaching Hospital, Lusaka, Zambia
| | - Mulindi H Mwanahamuntu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia ; University Teaching Hospital, Lusaka, Zambia
| | | | | | | | - Carla Chibwesha
- University of Alabama at Birmingham, AL, USA ; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Gracilia Mkumba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia ; University Teaching Hospital, Lusaka, Zambia
| | | | - Sharon Kapambwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia ; University Teaching Hospital, Lusaka, Zambia
| | | | | | - Jeffrey Sa Stringer
- University of Alabama at Birmingham, AL, USA ; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Benjamin H Chi
- University of Alabama at Birmingham, AL, USA ; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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Human papillomavirus genotypes distribution in cervical samples from women living with human immunodeficiency virus. Arch Gynecol Obstet 2010; 283:809-17. [DOI: 10.1007/s00404-010-1443-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 03/11/2010] [Indexed: 11/30/2022]
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Firnhaber C, Van Le H, Pettifor A, Schulze D, Michelow P, Sanne IM, Lewis DA, Williamson AL, Allan B, Williams S, Rinas A, Levin S, Smith JS. Association between cervical dysplasia and human papillomavirus in HIV seropositive women from Johannesburg South Africa. Cancer Causes Control 2010; 21:433-43. [PMID: 19949850 PMCID: PMC2835728 DOI: 10.1007/s10552-009-9475-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 11/10/2009] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the association between CD4 counts, HPV infection and the risk of cervical neoplasia among HIV-seropositive women. METHODS A cross-sectional observational study was conducted among 1,010 HIV-seropositive women using cytology-based Pap smears. HPV DNA testing using Linear Array genotyping assay (Roche) was carried out in a subset of 191 patients. Multivariable-adjusted prevalence ratios (mPR) and 95% confidence intervals (CIs) were estimated with log-binomial regression. RESULTS Among 1,010 HIV-seropositive women, the prevalence of AGC/ASCUS, LSIL and HSIL or greater was 8.3, 23.5 and 18.0%, respectively. The risk of cervical lesions was higher with CD4 < 200 cells/mm(3) vs. CD4 levels > 500/mm(3). HPV types 16 (41.7%) and HPV 56 (22.2%) were the most common types in HSIL cases. Women with CD4 levels < 200/mm(3) had a higher prevalence of HPV types 16 (p < 0.01) and 66 (p = 0.04). No statistical relationship between cervical lesions and HAART use was found. CONCLUSION The burden of HPV infection and HSIL was high and correlated with HIV-induced immunosuppression. HPV 16 was the most common type in HSIL and increased in prevalence with greater immune suppression. Prophylactic HPV 16 vaccination could prevent approximately 40% of HSIL cases. Strengthening screening programs is imperative in this population.
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Affiliation(s)
- Cynthia Firnhaber
- Department of Medicine, Clinical HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Hoa Van Le
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Campus Box 7435, Chapel Hill, NC 27599 USA
| | - Audrey Pettifor
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Campus Box 7435, Chapel Hill, NC 27599 USA
| | - Doreen Schulze
- Department of Medicine, Clinical HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Pam Michelow
- Cytology Unit National Health Laboratory Service, Johannesburg, South Africa
- Department of Pathology, University of Witwatersrand, Johannesburg, South Africa
| | - Ian M. Sanne
- Department of Medicine, Clinical HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - David A. Lewis
- STI Reference Centre, National Institute for Communicable Diseases (NHLS), Johannesburg, South Africa
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Anna-Lise Williamson
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Bruce Allan
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Allen Rinas
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Campus Box 7435, Chapel Hill, NC 27599 USA
| | - Simon Levin
- Department of OB/Gyn, Cornation Hospital, University of Witswaterand, Johannesburg, South Africa
| | - Jennifer S. Smith
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Campus Box 7435, Chapel Hill, NC 27599 USA
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The Bidirectional Interactions of Human Immunodeficiency Virus-1 and Sexually Transmitted Infections. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2009. [DOI: 10.1097/ipc.0b013e3181aba461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Massad LS, Xie X, Darragh TM, Minkoff H, Levine AM, D'Souza G, Cajigas A, Colie C, Watts DH, Strickler HD. Histologic correlates of glandular abnormalities in cervical cytology among women with human immunodeficiency virus. Obstet Gynecol 2009; 114:1063-1068. [PMID: 20168108 PMCID: PMC3032588 DOI: 10.1097/aog.0b013e3181bc6ce0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the frequency and histologic correlates of glandular abnormalities in cervical cytology among women with the human immunodeficiency virus (HIV) and to compare findings with those of women without HIV. METHODS In a cohort study of HIV-infected and uninfected women followed between 1994 and 2007, Pap tests were obtained every 6 months. Glandular abnormalities, including atypical glandular cells (AGC), adenocarcinoma in situ (AIS), and adenocarcinoma, were identified and correlated with biopsy histology. Multivariate models to summarize data across visits used generalized estimating equations. The association of Pap and histology results was assessed using chi tests. RESULTS Of 48,362 Pap tests from 3,766 women, glandular abnormalities were found in 341 (0.7%) tests from 244 (6%) women, including 93 (1.0%) of 9,564 Pap tests among HIV-seropositive women with CD4 lymphocyte counts less than 250/mm, 103 (0.8%) of 13,023 tests among those with counts 250-500/mm, 68 (0.6%) of 12,470 tests among women with counts greater than 500/mm, and 70 (0.6%) of 11,769 tests among HIV-seronegative women (P for trend=.006). Colposcopy was documented for only 148 (61%) of 244 index Pap tests in women with glandular abnormalities. After index abnormal tests, endocervical curettings were obtained from 106 (43%) women, cervical biopsies from 76 (38%), and endometrial biopsies from 19 (8%). Squamous lesions predominated among histologic findings and histology results did not differ by HIV serostatus (P=.16). CONCLUSION Although immunosuppression increased the risk of glandular Pap test abnormalities in women with HIV, these remained uncommon. Compliance with management guidelines can improved. LEVEL OF EVIDENCE II.
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Affiliation(s)
- L Stewart Massad
- From the Washington University School of Medicine, Springfield, Illinois; Albert Einstein College of Medicine, Bronx, New York; University of California, San Francisco, California; Maimonides Medical Center, Brooklyn, New York; City of Hope National Medical Center, Duarte, California, and Keck School of Medicine, University of Southern California, Los Angeles, California; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Montefiore Medical Center, Bronx, New York; Georgetown University, Washington, DC; Eunice Kennedy Shriver National Institute for Child Health and Human Development, Bethesda, Maryland; Albert Einstein College of Medicine, Bronx, New York
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Clifford GM, Franceschi S. Cancer risk in HIV-infected persons: influence of CD4(+) count. Future Oncol 2009; 5:669-78. [PMID: 19519206 DOI: 10.2217/fon.09.28] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Persons infected with HIV are at increased risk for all cancers known or suspected to have an infectious cause, an effect believed to be primarily mediated by lowered host immunity via the depletion of CD4(+) cells. Whereas Kaposi sarcoma and non-Hodgkin lymphoma were recognised as AIDS-defining illnesses early in the HIV epidemic, the influence of declining CD4(+) count on other infection-related cancers has taken longer to establish, undoubtedly because the association is weaker and the dose-response relationship is less steep. However, following improved survival made possible by combined antiretroviral therapy, declining CD4(+) count starts showing an impact on the natural history of various carcinogenic infections and on the risk for an increasingly wide range of cancers, including Hodgkin lymphoma, cervical, anal and liver cancers.
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Affiliation(s)
- Gary M Clifford
- International Agency for Research on Cancer, Lyon Cedex 08, France.
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Coelho Lima BM, Golub JE, Tonani Mattos A, Freitas LBD, Cruz Spano L, Espinosa Miranda A. Human papillomavirus in women with and without HIV-1 infection attending an STI clinic in Vitoria, Brazil. ACTA ACUST UNITED AC 2009; 8:286-90. [PMID: 19721099 DOI: 10.1177/1545109709341855] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We conducted a cross-sectional study in Vitória, Brazil, to assess the prevalence of human papillomavirus (HPV) infection in HIV-positive and HIV-negative women attending a sexually transmitted infection (STI)/AIDS clinic. We also investigated the presence of HPV genotypes and assessed covariates for HIV infection. Enrolled patients received a gynecological evaluation, and cervical scrape samples were collected for cytological analysis and HPV-DNA polymerase chain reaction (PCR). A blood sample was obtained to determine HIV status. HPV infection and squamous intraepithelial lesions were studied in 284 women, 112 (39.4%) HIV-positive women and 172 (60.5%) HIV-negative women. HPV-DNA was detected in 133 (46.8%). HIV-infected women were almost twice as likely to be concurrently infected with HPV than HIV-negative women (OR = 1.87 95% CI: 1.16-3.03). The high proportion of HPV detected among women attending an STI/AIDS clinic, particularly among HIV-infected women, proves the importance of screening this high-risk group in the hope of earlier detection and treatment of cervical intraepithelial neoplasia (CIN).
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Moodley JR, Constant D, Hoffman M, Salimo A, Allan B, Rybicki E, Hitzeroth I, Williamson AL. Human papillomavirus prevalence, viral load and pre-cancerous lesions of the cervix in women initiating highly active antiretroviral therapy in South Africa: a cross-sectional study. BMC Cancer 2009; 9:275. [PMID: 19664216 PMCID: PMC2739859 DOI: 10.1186/1471-2407-9-275] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 08/07/2009] [Indexed: 12/16/2022] Open
Abstract
Background Cervical cancer and infection with human immunodeficiency virus (HIV) are both important public health problems in South Africa (SA). The aim of this study was to determine the prevalence of cervical squamous intraepithelial lesions (SILs), high-risk human papillomavirus (HR-HPV), HPV viral load and HPV genotypes in HIV positive women initiating anti-retroviral (ARV) therapy. Methods A cross-sectional survey was conducted at an anti-retroviral (ARV) treatment clinic in Cape Town, SA in 2007. Cervical specimens were taken for cytological analysis and HPV testing. The Digene Hybrid Capture 2 (HC2) test was used to detect HR-HPV. Relative light units (RLU) were used as a measure of HPV viral load. HPV types were determined using the Roche Linear Array HPV Genotyping test. Crude associations with abnormal cytology were tested and multiple logistic regression was used to determine independent risk factors for abnormal cytology. Results The median age of the 109 participants was 31 years, the median CD4 count was 125/mm3, 66.3% had an abnormal Pap smear, the HR-HPV prevalence was 78.9% (Digene), the median HPV viral load was 181.1 RLU (HC2 positive samples only) and 78.4% had multiple genotypes. Among women with abnormal smears the most prevalent HR-HPV types were HPV types 16, 58 and 51, all with a prevalence of 28.5%. On univariate analysis HR-HPV, multiple HPV types and HPV viral load were significantly associated with the presence of low and high-grade SILs (LSIL/HSIL). The multivariate logistic regression showed that HPV viral load was associated with an increased odds of LSIL/HSIL, odds ratio of 10.7 (95% CI 2.0 – 57.7) for those that were HC2 positive and had a viral load of ≤ 181.1 RLU (the median HPV viral load), and 33.8 (95% CI 6.4 – 178.9) for those that were HC2 positive with a HPV viral load > 181.1 RLU. Conclusion Women initiating ARVs have a high prevalence of abnormal Pap smears and HR-HPV. Our results underscore the need for locally relevant, rigorous screening protocols for the increasing numbers of women accessing ARV therapy so that the benefits of ARVs are not partially offset by an excess risk in cervical cancer.
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Affiliation(s)
- Jennifer R Moodley
- School of Public Health and Family Medicine, Women's Health Research Unit, University of Cape Town, Cape Town, South Africa.
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Prevalence and persistence of cervical human papillomavirus infection in HIV-positive women initiating highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2009; 51:274-82. [PMID: 19387354 DOI: 10.1097/qai.0b013e3181a97be5] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the prevalence of human papillomavirus (HPV) DNA in cervical specimens from treatment-naive women initiating highly active antiretroviral therapy (HAART) and explore the longitudinal association of HPV DNA with CD4 count and HIV viral load (VL). METHODS Women enrolled before HAART were evaluated at baseline, weeks 24, 48, and 96 with CD4 count, VL, and cervical swab for HPV DNA. RESULTS The 146 subjects had a median CD4 count of 238 cells per microliter and VL of 13,894 copies per milliliter. Ninety-seven subjects (66%) had HPV DNA detected in the baseline specimen including 90 subjects (62%) positive for 1 or more high-risk HPV types. HPV DNA detection declined to 49% at week 96 and that of a high risk HPV type to 39%. The duration of follow-up was associated with decreased detection of HPV DNA of any type (P = 0.045) and of high-risk HPV types (P = 0.003). There was at most a marginal association between HAART response and loss of detection of cervical HPV DNA. CONCLUSIONS Women initiating HAART had a high prevalence of cervical HPV DNA that declined over 96 weeks of HAART. The relationship of CD4 count and VL response to the decline of cervical HPV DNA was not strong.
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Basu J, Romney SL, Angeletti RH, Vermund SH, Nieves E, Kadish AS, Mikhail MS, Orr GA. Human immunodeficiency virus (HIV) antigens and RNA in HIV-seronegative women with cervical intraepithelial neoplasia. AIDS Res Hum Retroviruses 2009; 25:249-59. [PMID: 19292595 DOI: 10.1089/aid.2008.0096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
While investigating whether proteins retrieved by cervicovaginal lavages (CVL) from women with cervical intraepithelial neoplasia (CIN) might correlate with risk of progression to invasive cervical cancer, we unexpectedly identified HIV gag and env glycoprotein in CVL from women with HIV-negative serology. HIV antigens were consistently identified by mass spectrometry (MS) in CVL from 4 women but were absent in CVL from the remaining 16 women. HIV serologies of all 20 patients were negative for both HIV-1 and HIV-2 antibodies. To validate the unexpected MS findings we performed Western blot (WB) and immunoaffinity chromatography (IC) analysis of CVL for HIV proteins, viral load assays of paired CVL and blood samples, and immunohistochemical HIV p24 expression in cervical biopsy specimens. WB analysis of CVL for prostate-specific antigen (PSA) was performed to exclude semen contamination as the source of HIV proteins. WB and IC results demonstrated the presence of HIV-1 gp41 and p24 antigens in four CVL that were identified by MS to have the HIV proteins. Despite negative serology, HIV RNA in CVL and HIV p24 in cervix biopsies were detected in patients with HIV antigen-positive CVL. HIV p24-positive CVL were PSA negative. All 20 subjects remained HIV seronegative throughout the study. Women with HIV proteins and RNA were comparatively older. Our findings suggest that CVL HIV proteins in women with CIN could be markers for unrecognized HIV exposure or subclinical infection. Proteomic screening of cervical secretions may be useful in identifying seronegative women exposed to HIV and/or at risk for AIDS.
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Affiliation(s)
- Jayasri Basu
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York 10461
| | - Seymour L. Romney
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York 10461
| | - Ruth H. Angeletti
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York 10461
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York 10461
| | - Sten H. Vermund
- Institute of Global Health and Department of Pediatrics, Vanderbilt University, School of Medicine, Nashville, Tennessee 37232-0242
| | - Edward Nieves
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York 10461
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York 10461
| | - Anna S. Kadish
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York 10461
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York 10461
| | - Magdy S. Mikhail
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York 10461
| | - George A. Orr
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, New York 10461
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Massad LS, Seaberg EC, Watts DH, Minkoff H, Levine AM, Henry D, Colie C, Darragh TM, Hessol NA. Long-term incidence of cervical cancer in women with human immunodeficiency virus. Cancer 2009; 115:524-30. [PMID: 19127538 PMCID: PMC2641995 DOI: 10.1002/cncr.24067] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The objective of this study was to estimate the incidence of invasive cervical cancer (ICC) in women with human immunodeficiency virus (HIV) and compare it with the incidence in HIV-uninfected women. METHODS In a cohort study of HIV-infected and uninfected women who had Papanicolaou tests obtained every 6 months, pathology reports were retrieved for women who had biopsy results or a self-report of ICC. Histology was reviewed when reports confirmed ICC. Incidence rates were calculated and compared with those in HIV-negative women. RESULTS After a median follow-up of 10.3 years, 3 ICCs were confirmed in HIV-seropositive women, and none were confirmed in HIV-seronegative women. The ICC incidence rate was not found to be associated significantly with HIV status (HIV-negative women [0 of 100,000 person-years] vs HIV-positive women [21.4 of 100,000 person-years]; P = .59). A calculated incidence rate ratio standardized to expected results from the Surveillance Epidemiology and End Results database that was restricted to HIV-infected Women's Interagency HIV Study participants was 1.32 (95% confidence interval, 0.27-3.85; P = 0.80). CONCLUSIONS Among women with HIV in a prospective study that incorporated cervical cancer prevention measures, the incidence of ICC was not significantly higher than that in a comparison group of HIV-negative women.
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Affiliation(s)
- L Stewart Massad
- Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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48
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HIV, human papillomavirus, and cervical neoplasia and cancer in the era of highly active antiretroviral therapy. Eur J Cancer Prev 2009; 17:545-54. [PMID: 18941376 DOI: 10.1097/cej.0b013e3282f75ea1] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The objective of this study was to review the literature on the epidemiological association between human papillomavirus (HPV), HIV, and cervical neoplasia, and the impact of highly active antiretroviral therapy (HAART) on this association. MEDLINE was searched using the terms 'human papillomavirus', 'HPV', 'HIV', 'cervix', 'neoplasm', and 'antiretroviral' to identify articles published before December 2006. HIV-infection was strongly associated with a higher prevalence, incidence, and persistence of HPV infection and correlated with prevalence, incidence, persistence, and progression of squamous intraepithelial lesions. The association between HIV and invasive cervical carcinoma has been more difficult to establish, but is now fully recognized. HAART seems to have little, if any, beneficial effect on the natural history of intraepithelial lesions in HIV-positive women. Despite this fact, HAART, does increase the life expectancy of HIV-positive women. Therefore, it remains important to closely monitor HPV-related disease in women with HIV who are receiving HAART, particularly in regions of the world where cervical screening is not available routinely.
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49
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Abstract
In this article, gynecologic conditions of increased importance in the HIV-infected woman are discussed. Women living with HIV may have an increase in menstrual disorders, lower genital tract neoplasias, gynecologic surgery, and sexually transmitted infections. The literature relevant to choosing a method of contraception for HIV-positive women is also discussed. With the advent of HAART, seropositive women are now facing issues around longevity, such as menopause and disorders of bone mineral density, as well as those associated with fertility.
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Affiliation(s)
- Helen E Cejtin
- Department of Obstetrics and Gynecology, John H. Stroger Jr Hospital of Cook County (formerly Cook County Hospital), 1901 W. Harrison, Chicago, IL 60612, USA.
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50
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Smith JS, Melendy A, Rana RK, Pimenta JM. Age-specific prevalence of infection with human papillomavirus in females: a global review. J Adolesc Health 2008; 43:S5-25, S25.e1-41. [PMID: 18809145 DOI: 10.1016/j.jadohealth.2008.07.009] [Citation(s) in RCA: 194] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Revised: 06/27/2008] [Accepted: 07/03/2008] [Indexed: 01/08/2023]
Abstract
PURPOSE Global data on age-specific prevalence of human papillomavirus (HPV) infection overall, and for high-risk HPV types 16 and 18, are essential for the future implementation of HPV prophylactic vaccines for cervical cancer prevention. METHODS A systematic review of peer-reviewed publications was conducted to summarize worldwide data on genital HPV-DNA prevalence in women. Studies with clear descriptions of polymerase chain reaction or hybrid capture detection assays were included. RESULTS A total of 346,160 women were included in 375 studies. Of 134 studies with age-stratified HPV prevalence data (116 low sexual risk populations, 18 high sexual risk populations), over 50% were from Europe and the Middle East (38%) and North America (19%), with smaller proportions from Asia and Australia (21%), Central and South America (11%), and Africa (10%). Across all geographical regions, data on HPV prevalence were generally limited to women over 18 years of age. Consistently across studies, HPV infection prevalence decreased with increasing age from a peak prevalence in younger women (< or =25 years of age). In middle-aged women (35-50 years), maximum HPV prevalence differed across geographical regions: Africa (approximately 20%), Asia/Australia (approximately 15%), Central and South America (approximately 20%), North America (approximately 20%), Southern Europe/Middle East (approximately 15%), and Northern Europe (approximately 15%). Inconsistent trends in HPV prevalence by age were noted in older women, with a decrease or plateau of HPV prevalence in older ages in most studies, whereas others showed an increase of HPV prevalence in older ages. Similar trends of HPV 16 and/or 18 prevalence by age were noted among 12 populations with available data. DISCUSSION Genital HPV infection in women is predominantly acquired in adolescence, and peak prevalence in middle-aged women appears to differ across geographical regions. Worldwide variations in HPV prevalence across age appear to largely reflect differences in sexual behavior across geographical regions. Further studies of HPV prevalence in adolescents are needed for all geographic regions.
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Affiliation(s)
- Jennifer S Smith
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
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