title: HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mumbai, India: 12-month follow-up.
abstract: BACKGROUND
  HIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.
  
  
  METHODS
  From May 2010 to October 2010, Médecins Sans Frontières and Tata Memorial Hospital Mumbai offered routine annual Pap smears and HPV DNA testing of women attending an antiretroviral therapy (ART) clinic and a 12-month follow-up. Women with abnormal test results were offered cervical biopsy and treatment, including treatment for sexually transmitted infections (STIs).
  
  
  RESULTS
  Ninety-five women were screened. Median age was 38 years (IQR: 33-41); median nadir CD4-count 143 cells/μL (IQR: 79-270); and median time on ART 23 months (IQR:10-41). HPV DNA was detected in 30/94 women (32%), and 18/94 (19%) showed either low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL) on Pap smear. Overall, >50% had cervical inflammatory reactions including STIs. Of the 43 women with a cervical biopsy, eight (8.4%) had CIN-1, five (5.3%) CIN-2, and two (2.1%) carcinoma in situ. All but one had HPV DNA detected (risk ratio: 11, 95% confidence interval: 3.3-34). By October 2011, 56 women had completed the 12-month follow-up and had been rescreened. No new cases of HPV infection/LSIL/HSIL were detected.
  
  
  CONCLUSIONS
  The high prevalence of HPV infection, STIs, and cervical lesions among women attending an ART clinic demonstrates a need for routine screening. Simple, one-stop screening strategies are needed. The optimal screening interval, especially when resources are limited, needs to be determined.
authors: Médecins sans Frontières, Mumbai, India ; Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
authors: Petros
authors: P
authors: Isaakidis
authors: Sharmila
authors: S
authors: Pimple
authors: Bhanumati
authors: B
authors: Varghese
authors: Samsuddin
authors: S
authors: Khan
authors: Homa
authors: H
authors: Mansoor
authors: Joanna
authors: J
authors: Ladomirska
authors: Neelakumari
authors: N
authors: Sharma
authors: Esdras Da
authors: ED
authors: Silva
authors: Carol
authors: C
authors: Metcalf
authors: Severine
authors: S
authors: Caluwaerts
authors: Petra
authors: P
authors: Alders
authors: Evangelia E
authors: EE
authors: Ntzani
authors: Tony
authors: T
authors: Reid
keywords: HIV/AIDS; HPV; India; cervical cancer; operational research; women’s health
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