Screening of cervical neoplasia in HIV-infected women in India.
OBJECTIVE
To evaluate an accurate, affordable, and feasible method to screen and treat HIV-infected women so that cervical cancer can be prevented among them.


METHODS
A cross-sectional study was conducted in India in which eligible HIV-infected women underwent visual inspection with acetic acid (VIA), visual inspection with Lugol's iodine (VILI), cytology, human papillomavirus (HPV) testing, and colposcopy.


METHODS
We screened women with cytology, HPV testing, VIA, and VILI. All screened women had colposcopy and women with colposcopic abnormalities had directed biopsies. Women with suspected cervical intraepithelial neoplasia (CIN) on colposcopy were treated with cold coagulation or loop excision. Sensitivity, specificity, and predictive values of the screening tests were calculated.


RESULTS
: Among 1128 women screened, 55 (4.9%) had CIN2-3 lesions. Sensitivity for VIA, VILI, cytology at atypical squamous cells of undetermined significance (ASCUS) threshold and HPV testing was 83.6, 89.1, 63.3, and 94.6%, and specificity was 88.8, 89.3, 94.5, and 77.4%, respectively, in detecting CIN2/3 lesions. Cytology had significantly lower sensitivity and higher specificity than VIA, VILI, and HPV testing. Sequential testing with VIA/VILI, HPV testing/VIA, HPV testing/VILI, and HPV testing/VIA/VILI had more balanced sensitivity and specificity than the single tests. Cold coagulation was well tolerated and cured 80% of CIN2-3 based on preliminary results at 6-month to 1-year follow-up periods.


CONCLUSIONS
Sequential testing with VIA and VILI is the most feasible screening approach for cervical cancer screening in HIV-infected women in low-resource countries. When HPV testing becomes feasible and affordable, HPV testing followed by VIA/VILI may be considered.
Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital Premises, Pune, Maharashtra, India.
Smita
S
Joshi
Rengaswamy
R
Sankaranarayanan
Richard
R
Muwonge
Vinay
V
Kulkarni
Thara
T
Somanathan
Uma
U
Divate
D019342:Acetic Acid; D000328:Adult; D004396:Coloring Agents; D003127:Colposcopy / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D007454:Iodides; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D014626:Vaginal Smears / Q000191:economics / Q000379:methods*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology
D004396:Coloring Agents; D007454:Iodides; D019342:Acetic Acid; C010389:Lugol's solution