title: High prevalence of cervical squamous intraepithelial lesions in women on antiretroviral therapy in Cameroon: Is targeted screening feasible?
abstract: BACKGROUND
  Cervical cancer is the most common cancer in women in low-income countries. Although cervical cancer incidence and mortality is higher in HIV-positive women, resource limitations restrict the implementation of systematic screening programs in these women. We explored the potential for targeted screening by assessing the prevalence, severity and predictors of cervical squamous intra-epithelial lesions (SILs) in HIV-positive women in Cameroon.
  
  
  RESULTS
  We conducted a cross-sectional study of women on antiretroviral therapy in Cameroon. Socio-demographic, behavioral, and clinical information was obtained from eligible women. Cervical exfoliated cells were then collected, a conventional cytology performed and epithelial lesions classified according to the Bethesda 2001 system. A total of 282 women, aged 19-68 years, were enrolled in this study. The median CD4 count was 179 cells/microliter (interquartile range: 100-271). SILs were detected in 43.5% of the 276 women with satisfactory samples: including atypical squamous cells of unknown significance (ASCUS) 0.7%, low-grade SIL (LSIL) 25.0%, atypical squamous cells, cannot exclude high grade lesions (ASC-H) 14.5%, and high-grade SIL (HSIL) 3.3%. None of the demographic or clinical characteristics considered significantly predicted the presence of any SILs or the presence of severe lesions requiring colposcopy.
  
  
  CONCLUSIONS
  The prevalence of SIL in women on antiretroviral therapy in Cameroon was high underscoring the need for screening and care in this population. In the absence of any accurate demographic or clinical predictor of SIL, targeted screening does not seem feasible. Alternative affordable screening options need to be explored.
authors: University of Buea, Cameroon. atashili@yahoo.ie
authors: Julius
authors: J
authors: Atashili
authors: Adaora A
authors: AA
authors: Adimora
authors: Peter M
authors: PM
authors: Ndumbe
authors: George M
authors: GM
authors: Ikomey
authors: Allen C
authors: AC
authors: Rinas
authors: Evan
authors: E
authors: Myers
authors: Joseph
authors: J
authors: Eron
authors: Jennifer S
authors: JS
authors: Smith
authors: William C
authors: WC
authors: Miller
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D018791:CD4 Lymphocyte Count; D002163:Cameroon / Q000453:epidemiology; D003127:Colposcopy; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D018307:Neoplasms, Squamous Cell / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D015995:Prevalence; D012720:Severity of Illness Index; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology
chemical_list: D019380:Anti-HIV Agents