title: Recurrence of cervical intraepithelial lesions after thermo-coagulation in HIV-positive and HIV-negative Nigerian women.
abstract: The burden of cervical cancer remains huge globally, more so in sub-Saharan Africa. Effectiveness of screening, rates of recurrence following treatment and factors driving these in Africans have not been sufficiently studied. The purpose of this study therefore was to investigate factors associated with recurrence of cervical intraepithelial lesions following thermo-coagulation in HIV-positive and HIV-negative Nigerian women using Visual Inspection with Acetic Acid (VIA) or Lugol's Iodine (VILI) for diagnosis.
  
  
  
  A retrospective cohort study was conducted, recruiting participants from the cervical cancer "see and treat" program of IHVN. Data from 6 sites collected over a 4-year period was used. Inclusion criteria were: age ≥18 years, baseline HIV status known, VIA or VILI positive and thermo-coagulation done. Logistic regression was performed to examine the proportion of women with recurrence and to examine factors associated with recurrence.
  
  
  
  Out of 177 women included in study, 67.8 % (120/177) were HIV-positive and 32.2 % (57/177) were HIV-negative. Recurrence occurred in 16.4 % (29/177) of participants; this was 18.3 % (22/120) in HIV-positive women compared to 12.3 % (7/57) in HIV-negative women but this difference was not statistically significant (p-value 0.31). Women aged ≥30 years were much less likely to develop recurrence, adjusted OR = 0.34 (95 % CI = 0.13, 0.92). Among HIV-positive women, CD4 count <200cells/mm(3) was associated with recurrence, adjusted OR = 5.47 (95 % CI = 1.24, 24.18).
  
  
  
  Recurrence of VIA or VILI positive lesions after thermo-coagulation occurs in a significant proportion of women. HIV-positive women with low CD4 counts are at increased risk of recurrent lesions and may be related to immunosuppression.
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA. imanueloga@gmail.com.|Institute of Human Virology Nigeria (IHVN), Abuja, Nigeria. imanueloga@gmail.com.
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Oga
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
authors.forename: Jessica P
authors.initials: JP
authors.lastname: Brown
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
authors.forename: Clayton
authors.initials: C
authors.lastname: Brown
authors.affiliation: Institute of Human Virology Nigeria (IHVN), Abuja, Nigeria.|Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Eileen
authors.initials: E
authors.lastname: Dareng
authors.affiliation: Institute of Human Virology Nigeria (IHVN), Abuja, Nigeria.
authors.forename: Victor
authors.initials: V
authors.lastname: Adekanmbi
authors.affiliation: Institute of Human Virology Nigeria (IHVN), Abuja, Nigeria.
authors.forename: Michael
authors.initials: M
authors.lastname: Odutola
authors.affiliation: National Hospital, Abuja, Nigeria.
authors.forename: Olayinka
authors.initials: O
authors.lastname: Olaniyan
authors.affiliation: University of Abuja Teaching Hospital, Gwagwalada, Nigeria.
authors.forename: Richard
authors.initials: R
authors.lastname: Offiong
authors.affiliation: Garki Hospital, Abuja, Nigeria.
authors.forename: Kayode
authors.initials: K
authors.lastname: Obende
authors.affiliation: Mother and Child Hospital, Ondo, Nigeria.
authors.forename: Ayodele Stephen
authors.initials: AS
authors.lastname: Adewole
authors.affiliation: Federal Medical Centre, Keffi, Nigeria.
authors.forename: Achara
authors.initials: A
authors.lastname: Peter
authors.affiliation: Institute of Human Virology Nigeria (IHVN), Abuja, Nigeria.
authors.forename: Patrick
authors.initials: P
authors.lastname: Dakum
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.|Institute of Human Virology Nigeria (IHVN), Abuja, Nigeria.|University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD, USA.|Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Clement
authors.initials: C
authors.lastname: Adebamowo
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004564:Electrocoagulation / Q000379:methods / Q000592:standards*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D015497:HIV-1 / Q000472:pathogenicity / Q000528:radiation effects; D006801:Humans; D053685:Laser Therapy / Q000379:methods / Q000592:standards; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000532:radiotherapy; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*
keywords: Ablation; Acetic acid; Cervical Intraepithelial Neoplasia (CIN); Cervical Intraepithelial lesions; Cervical cancer; Cold coagulation; HIV; Lugol’s Iodine; Recurrence; See-and-treat and Nigeria; Thermo-coagulation; Visual inspection