title: Prospective One Year Follow Up of HIV Infected Women Screened for Cervical Cancer Using Visual Inspection with Acetic Acid, Cytology and Human Papillomavirus Testing in Johannesburg South Africa.
abstract: BACKGROUND
  Cervical cancer is the most common cancer in Sub-Saharan Africa. There are little of HIV-infected women one-year after screening using visual inspection with acetic acid (VIA), HPV or cytology in sub-Saharan Africa.
  
  
  METHODS
  HIV-infected women in Johannesburg South Africa were screened one year later by Pap smear, VIA and human papillomavirus (HPV) testing. Women qualified for the 12 month follow-up visit if they had a negative or cervical intra-epithelial neoplasia (CIN) 1 results at the baseline visit. Modified Poisson regression was used to analyse associations between patient baseline characteristics and progression.
  
  
  RESULTS
  A total of 688 of 1,202 enrolled at baseline study who were CIN-2+ negative and qualified for a 12 month follow-up visit. Progression to CIN-2+ was higher in women with positive VIA results (12.6%; 24/191) than those VIA-negative (4.4%; 19/432). HPV-positive women at baseline were more likely to progress to CIN-2+ (12.3%; 36/293) than those HPV-negative (2.1%; 7/329). Cytology-positive women at baseline were more likely to progress to CIN-2+ (9.6%; 37/384) than cytology-negative women (2.5%; 6/237). Approximately 10% (10.4%; 39/376) of women with CIN 1 at baseline progressed to CIN 2+. Women who were VIA or HPV positive at baseline were more likely to progress aIRR 1.85, CI 95% (1.46 to 2.36), aIRR 1.41 CI 95% (1.14 to 1.75) respectively.
  
  
  CONCLUSIONS
  Progression to CIN-2+ in HIV-infected women is significant when measured by baseline positive VIA, HPV or Pap and yearly screening by any method should be considered in this population if possible.
authors.affiliation: Clinical HIV Research Unit, Faculty of Health Sciences, Department of Internal Medicine, University Witwatersrand, Johannesburg, South Africa.|Right to Care, Johannesburg, South Africa.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Firnhaber
authors.affiliation: Right to Care, Johannesburg, South Africa.
authors.forename: Bridgette
authors.initials: B
authors.lastname: Goeieman
authors.affiliation: Right to Care, Johannesburg, South Africa.
authors.forename: Mark
authors.initials: M
authors.lastname: Faesen
authors.affiliation: Right to Care, Johannesburg, South Africa.|Department of OB/GYN, Coronation Hospital, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Simon
authors.initials: S
authors.lastname: Levin
authors.affiliation: Right to Care, Johannesburg, South Africa.
authors.forename: Sophie
authors.initials: S
authors.lastname: Williams
authors.affiliation: Right to Care, Johannesburg, South Africa.
authors.forename: Sibongile
authors.initials: S
authors.lastname: Rameotshela
authors.affiliation: Clinical HIV Research Unit, Faculty of Health Sciences, Department of Internal Medicine, University Witwatersrand, Johannesburg, South Africa.
authors.forename: Avril
authors.initials: A
authors.lastname: Swarts
authors.affiliation: Cytology Unit, Department of Anatomical Pathology, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa.|National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Pam
authors.initials: P
authors.lastname: Michelow
authors.affiliation: National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Tanvier
authors.initials: T
authors.lastname: Omar
authors.affiliation: Institute of Infectious Disease and Division of Medical Virology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa.|National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: Anna-Lise
authors.initials: AL
authors.lastname: Williamson
authors.affiliation: National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: Bruce
authors.initials: B
authors.lastname: Allan
authors.affiliation: Right to Care, Johannesburg, South Africa.
authors.forename: Kate
authors.initials: K
authors.lastname: Schnippel
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America.|Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Smith
mesh_terms: D019342:Acetic Acid; D000328:Adult; D065309:Atypical Squamous Cells of the Cervix / Q000821:virology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D015897:Comorbidity; D018450:Disease Progression; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology*; D006301:Health Services Needs and Demand; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D013194:Staining and Labeling; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology
chemical_list: D019342:Acetic Acid