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PLoS One. 2016 Jan 5;11(1):e0144905. doi: 10.1371/journal.pone.0144905. eCollection 2016.

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

Author information

1
Clinical HIV Research Unit, Faculty of Health Sciences, Department of Internal Medicine, University Witwatersrand, Johannesburg, South Africa.
2
Right to Care, Johannesburg, South Africa.
3
Department of OB/GYN, Coronation Hospital, University of Witwatersrand, Johannesburg, South Africa.
4
Cytology Unit, Department of Anatomical Pathology, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa.
5
National Health Laboratory Service, Johannesburg, South Africa.
6
Institute of Infectious Disease and Division of Medical Virology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa.
7
National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.
8
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America.
9
Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America.

Abstract

BACKGROUND:

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

METHODS:

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

RESULTS:

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

CONCLUSION:

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

PMID:
26730710
PMCID:
PMC4701358
DOI:
10.1371/journal.pone.0144905
[Indexed for MEDLINE]
Free PMC Article

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