title: Risk factors for cervical intraepithelial neoplasia in HIV-infected women on antiretroviral treatment in Côte d'Ivoire, West Africa.
abstract: BACKGROUND
  Facing the dual burden of invasive cervical cancer and HIV in sub-Saharan Africa, the identification of preventable determinants of Cervical Intraepithelial Neoplasia (CIN) in HIV-infected women is of paramount importance.
  
  
  METHODS
  A cervical cancer screening based on visual inspection methods was proposed to HIV-infected women in care in Abidjan, Côte d'Ivoire. Positively screened women were referred for a colposcopy to a gynaecologist who performed directed biopsies.
  
  
  RESULTS
  Of the 2,998 HIV-infected women enrolled, 132 (4.4%) CIN of any grade (CIN+) were identified. Women had been followed-up for a median duration of three years [IQR: 1-5] and 76% were on antiretroviral treatment (ART). Their median most recent CD4 count was 452 [IQR: 301-621] cells/mm3. In multivariate analysis, CIN+ was associated with a most recent CD4 count >350 cells/mm3 (OR: 0.3; 95% CI: 0.2-0.6) or ≥200-350 cells/mm3 (OR 0.6; 95% CI 0.4-1.0) (Ref: <200 cells/mm3 CD4) (p<10-4).
  
  
  CONCLUSIONS
  The presence of CIN+ is less common among HIV-infected women with limited or no immune deficiency. Despite the potential impact of immunological recovery on the reduction of premalignant cervical lesions through the use of ART, cervical cancer prevention, including screening and vaccination remains a priority in West Africa while ART is rolled-out.
authors.affiliation: Université Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France; INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Jaquet
authors.affiliation: Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire (CHU) de Yopougon, Abidjan, Côte d'Ivoire.
authors.forename: Apollinaire
authors.initials: A
authors.lastname: Horo
authors.affiliation: Université Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France; INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France; Programme PACCI, CHU de Treichville, Abidjan, Côte d'Ivoire.
authors.forename: Didier K
authors.initials: DK
authors.lastname: Ekouevi
authors.affiliation: Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire (CHU) de Yopougon, Abidjan, Côte d'Ivoire.
authors.forename: Badian
authors.initials: B
authors.lastname: Toure
authors.affiliation: Programme PACCI, CHU de Treichville, Abidjan, Côte d'Ivoire.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Coffie
authors.affiliation: Service d'Anatomo-Pathologie, CHU de Treichville, Abidjan, Côte d'Ivoire.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Effi
authors.affiliation: Programme PACCI, CHU de Treichville, Abidjan, Côte d'Ivoire.
authors.forename: Severin
authors.initials: S
authors.lastname: Lenaud
authors.affiliation: CePReF, ACONDA, Abidjan, Côte d'Ivoire.
authors.forename: Eugene
authors.initials: E
authors.lastname: Messou
authors.affiliation: Centre Médical de Suivi de Donneurs de Sang/CNTS/PRIMO-CI, Abidjan, Cote d'Ivoire.
authors.forename: Albert
authors.initials: A
authors.lastname: Minga
authors.affiliation: Université Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France; INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France.
authors.forename: Annie J
authors.initials: AJ
authors.lastname: Sasco
authors.affiliation: Université Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France; INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France.
authors.forename: François
authors.initials: F
authors.lastname: Dabis
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002584:Cervix Uteri / Q000473:pathology; D003127:Colposcopy; D007560:Cote d'Ivoire / Q000453:epidemiology; D005260:Female; D006678:HIV / Q000187:drug effects / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000209:etiology*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000209:etiology*
chemical_list: D044966:Anti-Retroviral Agents