High-risk human papilloma virus and cervical abnormalities in HIV-infected women with normal cervical cytology.
BACKGROUND
The prevalence of High-Risk Human papilloma virus (HR-HPV), a necessary cause of invasive cervical cancer (ICC) is relatively high in HIV infected women. Gaps exist in our knowledge of the optimal approaches for managing women who have HR-HPV with normal cervical cytology (NCC) particularly in settings of HIV infection.


METHODS
Between May 2012 and June 2013 we conducted a colposcopic assessment of HIV-infected women with prior (NCC) and known HR-HPV status to compare cervical abnormalities in women with and without HR-HPV. Colposcopic examinations were done at the Operation Stop Cervical Cancer (OSCC) unit of the Jos University Teaching Hospital (JUTH), Jos, Nigeria. Abnormal colposcopic finding (ACF) was defined as areas of aceto-white epithelium involving the squamo-coulumnar junction, areas of punctation, mosaic pattern or atypical vessels. We compared proportions of ACF as well as histologic grades of cervical intra-epithelial neoplasia (CIN) in women with or without HR-HPV. Statistical analysis was done on STATA.


RESULTS
We conducted colposcopic examinations in 78 out of 89 (86.5%) eligible women. The mean age of the cohort was 32.4 years (SD ±4.6) with a median 32 years (IQR 29-36). After a mean follow up time of 20.1 months from the initial cervical pap cytology and HR-HPV testing, we found 12 of 78 (15.4%) women with ACF. The odds for an ACF was statistically higher [OR = 4.0 (95% CI: 1.1-14.7)] in women with HR-HPV compared to those without. Of the twelve women with ACF, subsequent histologic examination of colposcopically directed cervical biopsies confirmed CIN 1 in 4 cases (33.3%), CIN 2 in 1 case (8.3%), CIN 3 in 2 cases (16.7%), carcinoma-in-situ (CIS) in 2 cases (16.7%), and normal cervix in 3 (25.0%). Overall, the proportion of women detected with any grade of CIN was 11.5% (9/78) and 6.4% (5/78) were CIN 2 or greater lesion (CIN2+).


CONCLUSIONS
HIV-infected women with NCC and HR-HPV had a four-fold higher likelihood for an ACF. The practice of early colposcopic examination of HIV-infected women with prior NCC and HR-HPV may increase early detection of higher grade CIN and CIS cancer stages in our setting.
Department of Obstetrics and Gynecology, University of Jos, Jos, Plateau State Nigeria ; AIDS Prevention Initiative in Nigeria, HIV program, Jos University Teaching Hospital, Jos, Plateau State Nigeria.
Jonah
J
Musa
Center for Global Health, Northwestern University, Chicago, IL USA.
Chad
C
Achenbach
Center for Global Health, Northwestern University, Chicago, IL USA.
Babafemi
B
Taiwo
Center for Global Health, Northwestern University, Chicago, IL USA.
Baiba
B
Berzins
Department of Pathology, University of Jos, Jos, Plateau State Nigeria.
Olugbenga
O
Silas
Department of Obstetrics and Gynecology, University of Jos, Jos, Plateau State Nigeria.
Patrick H
PH
Daru
Department of Medicine, University of Jos, Jos, Plateau State Nigeria ; AIDS Prevention Initiative in Nigeria, HIV program, Jos University Teaching Hospital, Jos, Plateau State Nigeria.
Oche
O
Agbaji
Department of Obstetrics and Gynecology, University of Jos, Jos, Plateau State Nigeria ; AIDS Prevention Initiative in Nigeria, HIV program, Jos University Teaching Hospital, Jos, Plateau State Nigeria.
Godwin
G
Imade
Department of Obstetrics and Gynecology, University of Jos, Jos, Plateau State Nigeria ; AIDS Prevention Initiative in Nigeria, HIV program, Jos University Teaching Hospital, Jos, Plateau State Nigeria.
Atiene S
AS
Sagay
Department of Medicine, University of Jos, Jos, Plateau State Nigeria.
John A
JA
Idoko
Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA USA.
Phyllis J
PJ
Kanki
Center for Global Health, Northwestern University, Chicago, IL USA.
Robert L
RL
Murphy
Cervical cancer; Cervical cytology; HIV; HR-HPV; Nigeria