title: High rates of cervical cancer among HIV-infected women at a referral hospital in Malawi.
abstract: Cervical cancer is the most common cancer among women in Malawi. National guidelines recommend screening women aged 30-45 years every five years; however, no specific recommendations exist for women with HIV. We aimed to assess the frequency of high-grade dysplasia (CIN 2 or CIN3) and cervical cancer among women in central Malawi and to examine associations with CIN2+ (CIN2/3 or cancer). We extracted cervical Pap smear, biopsy, loop electrosurgical excision procedure and uterine specimen reports from a hospital pathology database from November 2012 to November 2013. We used logistic regression to estimate associations with CIN2+. We reviewed specimens from 824 women; we excluded 194 with unknown HIV status, leaving 630 in the analytic sample. Twelve percent had high-grade dysplasia and 109 women (17%) had cancer. Twenty-five percent of high-grade dysplasia cases and 35% of cancers occurred among women outside recommended screening ages. The odds of having CIN2+ were 6.55 times (95% CI 4.44-9.67) greater for HIV+ women. High-grade dysplasia and cervical cancer are very common among Malawian women, especially HIV+ women. HIV infection was strongly associated with CIN2+. Expanding screening to women not covered by current guidelines could avert a substantial proportion of cervical cancer cases in Malawi.
authors.affiliation: Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA rkohler@email.unc.edu.
authors.forename: Racquel E
authors.initials: RE
authors.lastname: Kohler
authors.affiliation: Division of Global Women's Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tang
authors.affiliation: Division of Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Satish
authors.initials: S
authors.lastname: Gopal
authors.affiliation: UNC Project Malawi, Lilongwe, Malawi.
authors.forename: Lameck
authors.initials: L
authors.lastname: Chinula
authors.affiliation: Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.affiliation: UNC Project Malawi, Lilongwe, Malawi.
authors.forename: N George
authors.initials: NG
authors.lastname: Liomba
authors.affiliation: Department of Obstetrics and Gynecology, Kamuzu Central Hospital, Lilongwe, Malawi.
authors.forename: Grace
authors.initials: G
authors.lastname: Chiudzu
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000166:cytology; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008875:Middle Aged; D011230:Precancerous Conditions / Q000453:epidemiology*; D012017:Referral and Consultation; D012189:Retrospective Studies; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D014626:Vaginal Smears
keywords: AIDS; Cervical cancer; HIV; HPV; Malawi; high-grade dysplasia; sub-Saharan Africa