title: A systematic review of the effects of visual inspection with acetic acid, cryotherapy, and loop electrosurgical excision procedures for cervical dysplasia in HIV-infected women in low- and middle-income countries.
abstract: BACKGROUND
  Cervical cancer, almost all of which is caused by human papillomavirus, accounts for 12% of female cancers worldwide and is more common among HIV-infected women. Nine of 10 deaths from cervical cancer occur in low- and middle-income countries (LMICs). Simple screening methods and outpatient treatment of precursor lesions save lives but the benefit of these interventions among HIV-infected women is uncertain.
  
  
  OBJECTIVE
  We reviewed evidence of the effects of screening with visual inspection with acetic acid (VIA), and outpatient treatment for cervical precancer among HIV-infected women in LMIC.
  
  
  METHODS
  A systematic review of articles published from January 1995 through July 2013 was conducted using key terms for VIA cervical screening, cervical precancer treatment with cryotherapy or loop electrosurgical excision procedure, HIV-infected women, low-resource settings, and outcomes, including morbidity and mortality.
  
  
  RESULTS
  Of 2159 articles screened, 14 met inclusion criteria; all considered only morbidity outcomes. No articles dealt with the long-term impact of screening/treatment on cervical cancer incidence or mortality among HIV-infected women. Articles reported on performance of VIA, prevalence of cervical dysplasia, and complications and rates of recurrent dysplasia after treatment.
  
  
  CONCLUSIONS
  Dysplasia prevalence and recurrence were higher among HIV-infected compared with HIV-uninfected women but morbidity from treatment was similar. Few data exist on long-term outcomes of VIA, cryotherapy, or loop electrosurgical excision procedure interventions among HIV-infected women in LMIC; longer-term outcomes research is needed to assess the effects of VIA or other screening modalities and outpatient treatment on prevention of cervical cancer among HIV-infected women.
authors.affiliation: *Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Atlanta, GA; †Division of AIDS National Institute of Allergy and Infectious Diseases, National Institutes of Health, US National Institutes of Health (NIH), Bethesda, MD; and ‡Office of the US Global AIDS Coordinator and Health Diplomacy (OGAC), Department of State, Washington, DC.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Forhan
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Godfrey
authors.forename: D Heather
authors.initials: DH
authors.lastname: Watts
authors.forename: Carol L
authors.initials: CL
authors.lastname: Langley
mesh_terms: D019342:Acetic Acid; D003362:Cost-Benefit Analysis; D017679:Cryotherapy; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D062489:Health Impact Assessment; D006295:Health Resources; D006801:Humans; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*
chemical_list: D019342:Acetic Acid