The battleground of two Infections and a cancer: Human Papilloma Virus, premalignant lesions of the cervix and their interaction with Human Immunodeficiency Virus in southwestern Nigeria
Författare
Summary, in Swedish
Popular Abstract in English
An increased risk of pre-cancer lesions of the cervix among HIV-infected women, and the positive impact of HIV treatment on its outcome has been reported globally. However there is paucity of information from west Africa with genetically distinct viral strains. Considering that HIV strains differ in the rate and pattern of HIV disease progression, a different outcome is expected. This study was conducted to determine the effect of HIV infection on the burden of pre-cancer lesions of the cervix; assess the diagnostic accuracy of visual inspection of the cervix; and contribute inform that is necessary for cervical cancer prevention and control programme in Nigeria. The study was conducted in southwest Nigeria among adult women of known HIV status(2011- 2012). In study I, the effect of HIV infection on the test performance of visual inspection of the cervix in detecting cervical pre-cancer lesions in 1140 women was determined. The effect of HIV infection and antiretroviral therapy on precancerous lesions of the cervix was determined in studies II and III. The acceptability of cervical cancer screening among 1517 HIV- positive women were determine in study IV and in study V we followed up women who tested positive at cervical cancer screening to determine rate and reason for default from follow- up .
This study demonstrates that cervical screening using visual inspection with Lugol’s iodine was inferior to screening with visual inspection with acetic acid in HIV positive women. The prevalence of high risk HPV and pre-cancerous lesions of the cervix were 19.6% and 8.4%, respectively. HPV 16 (3.9%), 35 (3.5%) and 58 (3.5%) were most frequently found high risk HPV type. HIV positive women were found to be at greater risk of high risk HPV infection and pre-cancer lesions of the cervix. The risk of infection with high risk HPV and development of precancerous lesions of cervix were reduced in those on HIV treatment compared to those not on treat. Although only 56.2% of HIV positive women were aware of cervical cancer screening, the test acceptable to over two-third of the women(79.8%). Among the 108 women who screened positive during community cervical cancer screening, 47.2% defaulted from follow -up as a result of transportation and cost- related issues and an anticipated long waiting time at the referral centre. Poorly educated women residing in the were most likely to default. Pre-cancer lesions of the cervix were found to be higher in HIV positive women, especially severely immuno-compromised ones and those not on treatment. Cervical cancer screening is acceptable to women but default from follow - up after positive screening was high, especially among poorly educated rural women.
The current strategy therefore needs to be changed to one that will integrate cervical cancer prevention into HIV care as well as to improve access to services for poorly educated women in rural communities.
An increased risk of pre-cancer lesions of the cervix among HIV-infected women, and the positive impact of HIV treatment on its outcome has been reported globally. However there is paucity of information from west Africa with genetically distinct viral strains. Considering that HIV strains differ in the rate and pattern of HIV disease progression, a different outcome is expected. This study was conducted to determine the effect of HIV infection on the burden of pre-cancer lesions of the cervix; assess the diagnostic accuracy of visual inspection of the cervix; and contribute inform that is necessary for cervical cancer prevention and control programme in Nigeria. The study was conducted in southwest Nigeria among adult women of known HIV status(2011- 2012). In study I, the effect of HIV infection on the test performance of visual inspection of the cervix in detecting cervical pre-cancer lesions in 1140 women was determined. The effect of HIV infection and antiretroviral therapy on precancerous lesions of the cervix was determined in studies II and III. The acceptability of cervical cancer screening among 1517 HIV- positive women were determine in study IV and in study V we followed up women who tested positive at cervical cancer screening to determine rate and reason for default from follow- up .
This study demonstrates that cervical screening using visual inspection with Lugol’s iodine was inferior to screening with visual inspection with acetic acid in HIV positive women. The prevalence of high risk HPV and pre-cancerous lesions of the cervix were 19.6% and 8.4%, respectively. HPV 16 (3.9%), 35 (3.5%) and 58 (3.5%) were most frequently found high risk HPV type. HIV positive women were found to be at greater risk of high risk HPV infection and pre-cancer lesions of the cervix. The risk of infection with high risk HPV and development of precancerous lesions of cervix were reduced in those on HIV treatment compared to those not on treat. Although only 56.2% of HIV positive women were aware of cervical cancer screening, the test acceptable to over two-third of the women(79.8%). Among the 108 women who screened positive during community cervical cancer screening, 47.2% defaulted from follow -up as a result of transportation and cost- related issues and an anticipated long waiting time at the referral centre. Poorly educated women residing in the were most likely to default. Pre-cancer lesions of the cervix were found to be higher in HIV positive women, especially severely immuno-compromised ones and those not on treatment. Cervical cancer screening is acceptable to women but default from follow - up after positive screening was high, especially among poorly educated rural women.
The current strategy therefore needs to be changed to one that will integrate cervical cancer prevention into HIV care as well as to improve access to services for poorly educated women in rural communities.
Avdelning/ar
Publiceringsår
2014
Språk
Engelska
Publikation/Tidskrift/Serie
Lund University Faculty of Medicine Doctoral Dissertation Series
Volym
2014:86
Fulltext
Dokumenttyp
Doktorsavhandling
Förlag
Division of Social Medicine and Global Health
Ämne
- Environmental Health and Occupational Health
Nyckelord
- antiretroviral drugs
- Human papilloma virus
- cervical cancer
- HIV/AIDS
- pre-cancerous lesions
- Nigeria
Status
Published
Forskningsgrupp
- Social Medicine and Global Health
- Social Medicine and Global Health
Handledare
- Karen Odberg Pettersson
- Per-Olof Östergren
ISBN/ISSN/Övrigt
- ISSN: 1652-8220
- ISBN: 978-91-7619-015-9
Försvarsdatum
24 oktober 2014
Försvarstid
09:00
Försvarsplats
CRC Aula, ingång 72, Jan Waldenströmsgata 35, Skånes Unviersitetssjukhus i Malmö
Opponent
- Elisabete Weiderpass Vaino (Professor)