HIV and pre-neoplastic and neoplastic lesions of the cervix in South Africa: a case-control study.
BACKGROUND
Cervical cancer and infection with human immunodeficiency virus (HIV) are both major public health problems in South Africa. The aim of this study was to determine the risk of cervical pre-cancer and cancer among HIV positive women in South Africa.


METHODS
Data were derived from a case-control study that examined the association between hormonal contraceptives and invasive cervical cancer. The study was conducted in the Western Cape (South Africa), from January 1998 to December 2001. There were 486 women with invasive cervical cancer, 103 control women with atypical squamous cells of undetermined significance (ASCUS), 53 with low-grade squamous intraepithelial lesions (LSIL), 50 with high-grade squamous intraepithelial lesions (HSIL) and 1159 with normal cytology. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multiple logistic regression.


RESULTS
The adjusted odds ratios associated with HIV infection were: 4.4 [95% CI (2.3 - 8.4) for ASCUS, 7.4 (3.5 - 15.7) for LSIL, 5.8 (2.4 - 13.6) for HSIL and 1.17 (0.75 - 1.85) for invasive cervical cancer. HIV positive women were nearly 5 times more likely to have high-risk human papillomavirus infection (HR-HPV) present compared to HIV negative women [OR 4.6 (95 % CI 2.8 - 7.5)]. Women infected with both HIV and high-risk HPV had a more than 40 fold higher risk of SIL than women infected with neither of these viruses.


CONCLUSIONS
HIV positive women were at an increased risk of cervical pre-cancer, but did not demonstrate an excess risk of invasive cervical cancer. An interaction between HIV and HR-HPV infection was demonstrated. Our findings underscore the importance of developing locally relevant screening and management guidelines for HIV positive women in South Africa.
Moodley
Jennifer R
JR
School of Public Health and Family Medicine, Women's Health Research Unit, University of Cape Town, 7925, South Africa. jmoodley@cormack.uct.ac.za
Hoffman
Margaret
M
Carrara
Henri
H
Allan
Bruce R
BR
Cooper
Diane D
DD
Rosenberg
Lynn
L
Denny
Lynette E
LE
Shapiro
Samuel
S
Williamson
Anna-Lise
AL
D000328:Adult; D016022:Case-Control Studies; D003271:Contraceptive Agents, Female; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D016017:Odds Ratio; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology; D011230:Precancerous Conditions / Q000150:complications / Q000453:epidemiology*; D013019:South Africa / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000453:epidemiology*; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000453:epidemiology
D003271:Contraceptive Agents, Female