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Houdou L, Meynard C, Guillerm S, Mimoun C, Lambert T, Marchand E, Jornet D, Fumagalli I, Quero L, Huchon C, Hennequin C. Monocentric Retrospective Study: Efficacy, Feasibility, and Prognostic Factors of Single-Insertion High-Dose-Rate Brachytherapy With 4 Sessions for Locally Advanced Cervical Cancer. Adv Radiat Oncol 2024; 9:101512. [PMID: 38883995 PMCID: PMC11177070 DOI: 10.1016/j.adro.2024.101512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/02/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose This study aims to assess the feasibility and efficacy of high-dose rate (HDR) brachytherapy (BT) administered in a single insertion with 4 treatment sessions for locally advanced cervical cancer and to identify the prognostic factors influencing outcomes. Methods and Materials We retrospectively analyzed the clinical data of patients with cervical cancer with locally advanced disease (International Federation of Gynecology and Obstetrics 2018 IB-IVB) treated at our institution from January 2014 through December 2021. Each patient received definitive radiation therapy with an external irradiation dosage between 45 and 50.4 Gy along with concurrent chemotherapy. HDR-BT (24 Gy) was prescribed to a high-risk clinical target volume. Results One hundred thirty-nine patients were included and the HDR-BT program could be fully performed in 136 patients (98%). Over a median follow-up duration of 40.5 months, the 2-year local control (LC), overall survival (OS), and disease-free survival rates stood at 79.4%, 77.7%, and 61.7%, respectively, with 5-year rates at 78.2%, 61.6%, and 55.7%. Multivariate analysis revealed the primary determinant of LC as the tumor's response to external beam radiation therapy as determined via magnetic resonance imaging before BT. Parametrial involvement demonstrated a significant multivariate association with disease-free survival (P = .04). Regarding OS, parametrial invasion (P = .01) and the tumor's response postchemoradiotherapy (P = .02) emerged as significant factors. Regarding chronic toxicities, 18% (25 patients) experienced grade 3 complications. An optimal D2 cc (bowel) threshold of 70 Gy (P = .001) was identified to limit chronic digestive complications of grade 3 or higher. Conclusions The implementation of single-insertion, 4-session HDR-BT could be performed in 98% of the patients. It yields favorable LC and OS rates, coupled with tolerable toxicity in patients with locally advanced cervical cancer. Response to initial chemoradiotherapy evaluated on pre-BT magnetic resonance imaging is an important prognostic factor and could help to individualize therapeutic strategies.
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Affiliation(s)
- Lucie Houdou
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France
| | - Claire Meynard
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France
| | - Sophie Guillerm
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France
| | - Camille Mimoun
- Gynecologic Department, Lariboisière Hospital, Paris, France
| | - Tiphaine Lambert
- Medical Oncology Department, Saint-Louis Hospital, Paris, France
| | - Eva Marchand
- Gynecologic Department, Lariboisière Hospital, Paris, France
| | - Diane Jornet
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France
| | - Ingrid Fumagalli
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France
| | - Laurent Quero
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France
- University of Paris-Cité, Cancer Institute of Oncology, Paris-Nord
| | - Cyrille Huchon
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France
- University of Paris-Cité, Cancer Institute of Oncology, Paris-Nord
| | - Christophe Hennequin
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France
- University of Paris-Cité, Cancer Institute of Oncology, Paris-Nord
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Onohuean H, Aigbogun EO, Igere BE. Meta-synthesis and science mapping analysis of HIV/HPV co-infection: a global perspective with emphasis on Africa. Global Health 2022; 18:36. [PMID: 35331267 PMCID: PMC8943940 DOI: 10.1186/s12992-022-00812-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background Viral infections are emerging with diverse clinical relevance both in endemic environments and non-endemic regions of the world. Some of the viruses cause co-infections that are of public health importance. The progress of studies on human immunodeficiency virus / Human papillomavirus (HIV/HPV) co-infection is not well documented especially in Africa where cases are endemic. Method Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a global three-decade meta-synthesis and science mapping analysis on HIV/HPV co-infections. Assessment of progress, Author/Country productivity/trends, topic conceptual framework, and international collaborative networks were analyzed. Results We recovered 196 documents of 115 sources from the web of science database. The meta-synthesis revealed 1203 prolific authors containing nine solo authors, an annual growth rate of 8.09%, a significant average citation per article of 20.7%, and an average citation per year per document of 2.1. A significant high correlation between the mean/TC per article and the mean total citation (TC) per year showed 80.98% of the articles produced between 2005 and 2007 on HPV/HIV co-infection. The co-author per document index were 7.0 and the collaboration index was 6.4. The meta-analysis also revealed inadequate funding from individual or governmental organizations; among the 196 documents dataset, 114 (58.2%) were funded, and only 31 (15.8%) were funded in Africa where HIV/HPV co-infection cases are endemic. Conclusions Authors’ collaboration network, countries’ collaboration, authors’ citations and implementation of research-based finding in previous studies are yet to receive the relevant outcome, especially as various countries in the African continent have received poor funding with a repeated reporting of co-infection associated with HIV/HPV. African needs to re-awaken and stir up research-based interest in HPV/HIV co-infection studies to resolve indigenous public health concerns associated with the viral endemicity.
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Affiliation(s)
- Hope Onohuean
- Biopharmaceutics Unit, Pharmacology and Toxicology, School of Pharmacy, Kampala International University, Western Campus, Ishaka-Bushenyi, Uganda. .,Biomolecules, Metagenomics, Endocrine and Tropical Disease Research Group (BMETDREG), Kampala International University, Western Campus, Ishaka-Bushenyi, Uganda.
| | - Eric O Aigbogun
- Biomolecules, Metagenomics, Endocrine and Tropical Disease Research Group (BMETDREG), Kampala International University, Western Campus, Ishaka-Bushenyi, Uganda.,Department of Human Anatomy, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Ishaka-Bushenyi, Uganda
| | - Bright E Igere
- Department of Microbiology and Biotechnology, Western Delta University Oghara, Oghara, Delta State, Nigeria
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Kowo M, Nzoume Nsope Mengang JM, Simeni Njonnou SR, Kouotou EA, Atangana PJA, Ankouane Andoulo F. Giant anogenital tumor of Buschke-Löwenstein in a patient living with human immunodeficiency virus/acquired immunodeficiency syndrome: a case report. J Med Case Rep 2022; 16:116. [PMID: 35303943 PMCID: PMC8932054 DOI: 10.1186/s13256-022-03339-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/18/2022] [Indexed: 08/29/2023] Open
Abstract
Background Buschke–Löwenstein tumor is a giant condyloma acuminata infection that is characterized by degeneration, invasion, and recurrence. It is associated with human papilloma virus infection. It develops around the genital and perineal area, sometimes causing a large budding ulcerated lesion. Although human immunodeficiency virus infection is frequent in Africa, there are few descriptions of Buschke–Löwenstein tumor diagnosis and its management. Screening for other sexually transmitted infections must be systematic among these patients. Case presentation We report herein the case of a 21-year-old African origin male patient who developed a perineal swelling. Physical examination showed evidence of a huge exophytic tumor made up of budding pinkish vegetations, with serrated crests, a ‘’butterfly wing’’ structure, and a cauliflower-like appearance crowned with centrifugal circinate lesions. Multiple condylomatous lesions of the anal margin were also present. The patient tested positive for human immunodeficiency virus (cluster of differentiation 4 count of 119 cells/mm3) and hepatitis B infections. Real-time polymerase chain reaction revealed human papilloma virus-16 and other high-risk human papilloma virus deoxyribonucleic acid. The diagnosis of Buschke–Löwenstein tumor was made on mass biopsy, and the patient underwent multidisciplinary intervention (surgery, podophyllin application, and antiretroviral therapy). Medium-term evolution was, however, fatal due to opportunistic infection. Conclusion Buschke–Löwenstein tumor is a rare tumor associated with human immunodeficiency virus infection. It is more frequent in male human immunodeficiency virus-positive patients. There is a need to screen for other sexually transmitted infections. In most cases, the treatment is surgical, in association with local therapies. However, recurrences are common.
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Affiliation(s)
- Mathurin Kowo
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.,Yaounde University Teaching Hospital, Yaounde, Cameroon
| | - Jude-Marcel Nzoume Nsope Mengang
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Sylvain Raoul Simeni Njonnou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon. .,Dschang District Hospital, Dschang, Cameroon.
| | - Emmanuel Armand Kouotou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.,Yaounde University Teaching Hospital, Yaounde, Cameroon
| | - Paul Jean Adrien Atangana
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Firmin Ankouane Andoulo
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.,Yaounde Central Hospital, Yaounde, Cameroon
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CD4 Trajectory Models and Onset of Non-AIDS-Defining Anal Genital Warts, Precancer, and Cancer in People Living With HIV Infection-1. Sex Transm Dis 2021; 47:628-633. [PMID: 32530855 PMCID: PMC7447125 DOI: 10.1097/olq.0000000000001215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Using single CD4 measure to predict the onset of comorbidities among people living with HIV infection-1 is common, but incorporating longitudinal CD4 measures in risk assessments may be more precise and informative. Background It is unclear how the characteristics of CD4 counts predict non–AIDS-defining human papillomavirus–related anogenital warts (AGWs) and anal high-grade squamous intraepithelial lesions/cancer (HSIL+) in people living with HIV infection-1 (PLWH). We compared the associations between 3 CD4 counts measures and these disease outcomes in the study. Methods Retrospective sociobehavioral and clinical data from electronic health records of 4803 PLWH from 2006 to 2018 were included. Three different measurements of CD4 counts—(a) nadir, (b) median, and (c) trajectory—were estimated. Six CD4 trajectory groups were constructed using the group-based trajectory modeling from all patients older than 18 years with ≥3 clinical visits. Univariate and multivariable logistic regression models were used to assess the associations with AGW and HSIL+, separately. Results A total of 408 AGW, 102 anal HSIL+ (43 HSIL, 59 cancer), 4 penile cancer, and 15 vaginal cancer cases were observed. Median CD4 (<200 cell/μL) was associated with AGW (odds ratio [OR], 2.2 [95% confidence interval {CI}, 1.6–3.0]), and anal HSIL+ (OR, 2.7 [95% CI, 1.5–5.0]; each, P < 0.001). Low nadir CD4 (<200 cell/μL) was associated with AGW (OR, 1.8 [95% CI, 1.3–2.6]) and anal HSIL+ (OR, 2.4 [95% CI, 1.2–4.7]; each, P ≤ 0.001). Different patterns (declining and sustained low CD4 counts) of CD4 trajectories showed the strongest associations with onset of both AGW (OR, 1.8–3.1) and HSIL+ (OR, 2.7–6.7). Conclusions People living with HIV infection-1 with the same median CD4 could have very different CD4 trajectories, implying different dynamics of immune status. CD4 trajectory could be a better predictor of incident AGW and HSIL+ among PLWH.
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Okoye JO, Ngokere AA, Erinle C, Mbamalu C. Co-existence of Herpes simplex virus type 2 and two other oncoviruses is associated with cervical lesions in women living with HIV in South-Western Nigeria. Afr Health Sci 2020; 20:1015-1023. [PMID: 33402947 PMCID: PMC7751508 DOI: 10.4314/ahs.v20i3.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The prevalence of Herpes simplex virus type 2 (HSV-2) in cervical lesions is under-reported, especially in Human immunodeficiency virus (HIV), Epstein-Barr virus (EBV) and Human Papillomavirus (HPV) infected persons. Objectives This study determined the prevalence of viral mono-infections, co-infections and squamous cell intraepithelial lesions (SIL) in HIV seropositive (HIV+) and HIV seronegative (HIV-) women. Methods This study included HIV+ and HIV- women (105 each). Cervical smears and viral antibodies were evaluated by Papanicolaou's technique and ELISA method, respectively. Results The prevalence of HSV-2, HPV and EBV infections, and SIL were higher in HIV+ women (75.2, 41.9, 41 and 32.4%) than in HIV- women (45.7, 26.7, 26.7 and 13.3%) at p< 0.0001, p= 0.029, 0.041 and 0.002, respectively. Higher prevalence of viral mono-infection and tri-infection was observed in HIV+ women (43.8 and 24.8%) than in HIV- women (27.6 and 8.6%) at p= 0.021, and 0.003, respectively. The prevalence of SIL was also higher in HIV+ women with viral mono-infection, bi-infection and tri-infection (15.2, 42.9, and 53.8%) than in HIV- women (6.9, 12.5, and 44.4%) at p= 0.468, 0.041, and 0.711, respectively. Conclusion This study suggests that the high prevalence of SIL in HIV+ women could be associated with viral co-infections.
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Affiliation(s)
- Jude Ogechukwu Okoye
- Nnamdi Azikiwe University, Medical Laboratory Science; Babcock University, Medical Laboratory Science
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Suehiro TT, Damke GMZF, Damke E, de Azevedo Ramos PLR, de Andrade Pereira Silva M, Pelloso SM, Huh WK, Franco RAF, da Silva VRS, Scarinci IC, Consolaro MEL. Cervical and oral human papillomavirus infection in women living with human immunodeficiency virus (HIV) and matched HIV-negative controls in Brazil. Infect Agent Cancer 2020; 15:31. [PMID: 32426032 PMCID: PMC7216672 DOI: 10.1186/s13027-020-00301-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022] Open
Abstract
Background Despite the demonstrated role of human Papillomavirus (HPV) in the etiology of cervical cancer and the strong evidence suggesting the importance of HPV in the development of oropharyngeal cancer, several aspects of the interrelationship between HPV infection in both body sites remain unknown, specifically in female human immunodeficiency virus (HIV)-positive (HIV+) patients. We aimed to assess the prevalence, distribution, and concordance of cervical and oral HPV in HIV+ women and matched HIV-negative (HIV-) controls in Brazil. Material and methods Cervical and endocervical samples for cytological screening and HPV detection and oral samples were collected from 115 HIV+ women using highly active antiretroviral therapy (HAART) and 139 HIV-matched controls (HIV-) in Maringá City, Brazil. Risk factors were assessed using a standardized questionnaire, and the data regarding HIV infection were obtained from the patients’ medical records. HPV detection and typing were performed using the Kit Multiplex XGEN Multi HPV Chip HS12. Results HIV infection was well controlled in this cohort, but women who exhibited detectable HIV loads were significantly associated with HPV-positive status overall (P = 0.03) and in cervical mucosa (P = 0.01). HIV+ women had significantly more abnormal cytological findings (P = 0.04) than HIV- women. Of the 115 HIV+ women, 48.7% were positive for cervical and/or oral HPV DNA; of the 139 HIV- women, 41% were positive for cervical and/or oral HPV (P = 0.25). Both HIV+ and HIV- women had a statistically higher prevalence of cervical HPV infection than oral infection. The concurrent HPV infection in two anatomical sites was similar in HIV+ and HIV- women; however, HPV type concordance was not observed. HPV type distribution was different between the anatomical sites in both groups, and HIV+ women presented less common types, mainly in oral mucosa. Conclusion Our data support the importance of testing HPV infection in HIV+ women, even when the HIV infection is well controlled. Prospective studies are required to better understand the natural history of HPV infection in both anatomical sites, specifically in HIV+ women.
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Affiliation(s)
- Tamy Taianne Suehiro
- 1Laboratory of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | | | - Edilson Damke
- 1Laboratory of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | | | | | | | - Warner K Huh
- 3School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | | | - Vânia Ramos Sela da Silva
- 1Laboratory of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | | | - Marcia Edilaine Lopes Consolaro
- 1Laboratory of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
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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: 28] [Impact Index Per Article: 7.0] [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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Belglaiaa E, Souho T, Badaoui L, Segondy M, Prétet JL, Guenat D, Mougin C. Awareness of cervical cancer among women attending an HIV treatment centre: a cross-sectional study from Morocco. BMJ Open 2018; 8:e020343. [PMID: 30139893 PMCID: PMC6112383 DOI: 10.1136/bmjopen-2017-020343] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To explore awareness about cervical cancer among Moroccan women attending an HIV treatment centre in Laâyoune city, Morocco. DESIGN A cross-sectional study was conducted from April to June 2017 using a knowledge test regarding cervical cancer, its risk factors and its prevention. SETTING HIV treatment centre at the Hospital of Moulay Hassan Ben Elmehdi in Laâyoune city, Morocco. PARTICIPANTS One hundred and twenty-three HIV-positive women aged 19 years and older were recruited to this study. RESULTS A total of 115 women were eligible to participate in the study. The average age was 34.9±10.2 years. Few women (20%) had heard about cervical cancer and its screening, the majority (17.4%) having received information from mass media. The vast majority (79.1%) of respondents had no knowledge of cervical cancer risk factors, and 80.8% did not know any symptoms of cervical cancer. Only 13% had undergone a Pap smear test. The main reason for not seeking Pap smear was the absence of symptoms (47%). CONCLUSION Our study documents poor awareness of cervical cancer. Given that the HIV-positive population is at increased risk of cervical cancer, health education programmes should be promoted to increase awareness of cervical cancer as well as access and participation in cervical cancer screening.
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Affiliation(s)
- Essaada Belglaiaa
- Service des soins infirmiers, Institut Supérieur des Professions Infirmières et Techniques de Santé, Laâyoune, Morocco
- EA 3181, LabEx LipSTIC ANR-11-LABX-0021, Université Bourgogne Franche-Comté, Besançon, France
| | - Tiatou Souho
- Faculté des Sciences et Techniques, Université de Kara, Kara, Togo
| | - Latifa Badaoui
- Service de Médecine, Hôpital Moulay Hassan ibn Mehdi, Laâyoune, Morocco
| | - Michel Segondy
- INSERM UMR1058 Pathogenèse et contrôle des infections chroniques, Université de Montpellier, Montpellier, France
| | - Jean-Luc Prétet
- EA 3181, LabEx LipSTIC ANR-11-LABX-0021, Université Bourgogne Franche-Comté, Besançon, France
- Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, France
| | - David Guenat
- EA 3181, LabEx LipSTIC ANR-11-LABX-0021, Université Bourgogne Franche-Comté, Besançon, France
- Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, France
| | - Christiane Mougin
- EA 3181, LabEx LipSTIC ANR-11-LABX-0021, Université Bourgogne Franche-Comté, Besançon, France
- Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, France
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Chambuso RS, Shadrack S, Lidenge SJ, Mwakibete N, Medeiros RM. Influence of HIV/AIDS on Cervical Cancer: A Retrospective Study From Tanzania. J Glob Oncol 2016; 3:72-78. [PMID: 28717744 PMCID: PMC5493231 DOI: 10.1200/jgo.2015.002964] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose Cervical cancer is the leading cause of cancer-related morbidity and mortality in women in Tanzania. Any impact of the HIV/AIDS epidemic on cervical precancerous lesions and invasive cervical cancer has a significant implication, as for any public health concern, especially in an area such as the Morogoro region in Tanzania, which has one of the highest rates of cervical cancer in the world. Methods A comparative retrospective study was performed of 536 women screened for cervical cancer by visual inspection methods at the Morogoro Regional Referral Hospital over a period of 3 years; the women were grouped according to their HIV status. The odds ratios (OR) with 95% CIs were estimated using χ2 test and multivariate analysis. The test statistics were evaluated with a significance level of P < .05. Results The prevalence of precancerous lesions was 71.8% in HIV-positive women and 27.3% in HIV-seronegative women. Furthermore, the prevalence of extensive or large precancerous lesions was 40.5% in HIV-positive women and 13.5% in HIV-seronegative women. The prevalence of invasive cervical cancer was 8% in HIV-seronegative women and 11% in HIV-positive women. The risk factors for the cervical lesions were HIV-positive status (OR, 6.8; 95% CI, 4.2 to 11.2; P < .001) and being older than 30 years of age (OR, 11.99; 95% CI, 6.86 to 21.21; P < .001). Conclusion HIV/AIDS has a highly statistically significant association with (P < .001) and a great influence on the development of cervical precancerous lesions in HIV-positive women; however, its direct involvement in the progression to invasive cervical cancer, especially in this era of highly active antiretroviral therapy, is questionable.
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Affiliation(s)
- Ramadhani S Chambuso
- and , Morogoro Regional Referral Hospital, Morogoro; and , Ocean Road Cancer Institute, Dar Es Salaam, Tanzania; and , Institute of Biomedical Sciences Abel Salazar of the University of Porto; and , Institute of Portuguese Oncology Francisco Gentil, Porto, Portugal
| | - Stephen Shadrack
- and , Morogoro Regional Referral Hospital, Morogoro; and , Ocean Road Cancer Institute, Dar Es Salaam, Tanzania; and , Institute of Biomedical Sciences Abel Salazar of the University of Porto; and , Institute of Portuguese Oncology Francisco Gentil, Porto, Portugal
| | - Salum J Lidenge
- and , Morogoro Regional Referral Hospital, Morogoro; and , Ocean Road Cancer Institute, Dar Es Salaam, Tanzania; and , Institute of Biomedical Sciences Abel Salazar of the University of Porto; and , Institute of Portuguese Oncology Francisco Gentil, Porto, Portugal
| | - Ntoli Mwakibete
- and , Morogoro Regional Referral Hospital, Morogoro; and , Ocean Road Cancer Institute, Dar Es Salaam, Tanzania; and , Institute of Biomedical Sciences Abel Salazar of the University of Porto; and , Institute of Portuguese Oncology Francisco Gentil, Porto, Portugal
| | - Rui M Medeiros
- and , Morogoro Regional Referral Hospital, Morogoro; and , Ocean Road Cancer Institute, Dar Es Salaam, Tanzania; and , Institute of Biomedical Sciences Abel Salazar of the University of Porto; and , Institute of Portuguese Oncology Francisco Gentil, Porto, Portugal
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Williams M, Moneyham L, Kempf MC, Chamot E, Scarinci I. Structural and sociocultural factors associated with cervical cancer screening among HIV-infected African American women in Alabama. AIDS Patient Care STDS 2015; 29:13-9. [PMID: 25514125 DOI: 10.1089/apc.2014.0063] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
African American women have disproportionately high prevalence rates of HIV and cervical cancer. HIV-infected women are significantly less likely to obtain recommended cervical cancer screenings than HIV-uninfected women. The purpose of this study was to examine sociocultural and structural factors associated with cervical cancer screening among HIV-infected African American in Alabama. The PEN-3 Model and the Health Belief Model were used as theoretical frameworks. In-depth interviews were conducted with twenty HIV-infected African American women to identify perceptions, enablers, and nurturers, perceived susceptibility, perceived severity, and perceived benefits related to cervical cancer and screening. The most common positive perceptions, enablers, and nurturers that contributed to cervical cancer screening included internal motivation and awareness of the importance of HIV-infected women getting Pap tests due to their weakened immune system. Negative perceptions, enablers, and nurturers included lack of knowledge about cervical cancer and screening, and lack of perceived susceptibility to cervical cancer. The results of this study can be used to guide the development of culturally relevant cervical cancer and screening education interventions aimed at increasing cervical cancer screening adherence among HIV-infected African American women.
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Affiliation(s)
- Michelle Williams
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Linda Moneyham
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Eric Chamot
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Isabel Scarinci
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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van Bogaert LJ. The impact of human immunodeficiency virus infection on cervical preinvasive and invasive neoplasia in South Africa. Ecancermedicalscience 2013; 7:334. [PMID: 23882298 PMCID: PMC3716340 DOI: 10.3332/ecancer.2013.334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Sub-Saharan Africa is at the epicentre of the human immunodeficiency virus (HIV) epidemic and has the highest incidence of invasive cervical cancer (ICC) in the world. Access to highly active antiretroviral treatment (HAART) in South Africa is still limited and provided only to nonpregnant women with a CD4+ T-cell count <200 μg/L. We evaluated the relative distribution of cervical preinvasive and invasive neoplasia among HIV-infected (treated or not) and uninfected women in the Limpopo Province of South Africa. METHODS We compared the consecutive biopsy-diagnosed cervical pathology of 1,023 HIV-infected and 1,023 uninfected women. We investigated the influence of the CD4+ T-cell count and of HAART on the relative distribution of cervical pathology. RESULTS There was a significantly higher proportion of cervical intraepithelial neoplasia (CIN)1 (P = 0.012) and 2 (P = 0.01) but a lower proportion of ICC (P = 0.015) among HIV-infected women. Patients on HAART had less CIN1 (P = 0.018), 2 (P = 0.18) and ICC (P = 0.019) that their untreated counterparts. The mean CD4 count was similar regardless of cervical lesions and HAART or no treatment. CONCLUSION Our data support the concept that HIV-infected women exhibit a higher rate of high-grade preinvasive lesions than uninfected controls. However, they have a significantly lower rate of ICC as compared with uninfected counterparts. The inclusion of ICC among acquired immune deficiency syndrome-defining illnesses is questionable.
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Affiliation(s)
- Louis-Jacques van Bogaert
- National Health Laboratory Service, Polokwane/Mankweng Hospital Complex, University of Limpopo, Polokwane 0700, South Africa
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12
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Freeman-Wang T, Walker P. Colposcopy in special circumstances: Pregnancy, immunocompromise, including HIV and transplants, adolescence and menopause. Best Pract Res Clin Obstet Gynaecol 2011; 25:653-65. [PMID: 21843974 DOI: 10.1016/j.bpobgyn.2011.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 04/26/2011] [Accepted: 05/09/2011] [Indexed: 10/17/2022]
Abstract
The true value of colposcopy in pregnancy is under debate; the examination may be more difficult depending on the gestation at which a woman presents. Cervical intraepithelial neoplasia does not have an accelerated progression during pregnancy, and treatment is usually deferred until postpartum. The prevalence of cervical intraepithelial neoplasia is greater in women with immune compromise. Those with human immunodeficiency have a higher prevalence, more persistence and less regression of human papillomavirus-related infections. Cervical cancer remains an AIDS-defining illness. Women who have had renal transplants also have a higher risk of developing cervical intraepithelial neoplasia. By contrast, other chronic illnesses that require immunosuppressant therapy do not seem to show this added risk. In young women, human papillomavirus infection is common and cervical intraepithelial neoplasia is also evident, but regression of these lesions is frequent and so conservative review may be appropriate. At the menopause, colposcopy is often unsatisfactory. The use of human papillomavirus testing for triage of low-grade cytological abnormalities may benefit this age group.
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Kwong JJ, Cook P, Bradley-Springer L. Improving anal cancer screening in an ambulatory HIV clinic: experience from a quality improvement initiative. AIDS Patient Care STDS 2011; 25:73-8. [PMID: 21235393 DOI: 10.1089/apc.2010.0122] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Evidence suggests that persons living with HIV (PLWH) are at increased risk for anal cancer. Early detection of anal cancer is an important prevention measure, but screening rates have been low. This report describes the experience of a quality improvement initiative to increase anal cancer screening at an HIV-specialty clinic. Chart reviews were conducted for three time periods: baseline year, prior to program discussion; transition year, during planning; and implementation year, during program availability. Odds ratios using Fisher's exact test showed that the odds of receiving anal cancer screening increased significantly in the transition year, odds ratio (OR) = 2.859, 95% confidence interval (CI): [1.798; 4.546], Fisher's z = 4.40, p < 0.0001, and in the implementation year, OR = 7.446, 95% CI: [4.783; 11.588], Fisher's z > 8.2, p < 0.0001. Patients and clinicians reported high levels of satisfaction with the program. Referring clinicians were also more likely to discuss anal cancer screening.
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Affiliation(s)
| | - Paul Cook
- College of Nursing, Aurora, Colorado
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Detection of Human Papillomavirus DNA in Plucked Eyebrow Hair from HIV-Infected Patients. J Invest Dermatol 2010; 130:2499-502. [DOI: 10.1038/jid.2010.147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Condyloma Mistaken for Stool Contamination in a Human Immunodeficiency Virus Patient by Gallium-67 Scintigraphy. Am J Med Sci 2010; 339:83-5. [DOI: 10.1097/maj.0b013e3181b8b8db] [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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