Main Article Content
Background: Cervical precancer lesions, caused by persistence of human papilloma virus (HPV) infection, is common among women living with Human immunodeficiency virus (HIV) infection. However, there remains paucity of information on these dysplastic lesions especially in low- and middle-income countries of the world as there are few programmes that have incorporated routine screening as a standard of care.
Aim: To determine the pattern of precancer lesions of the cervix among treatment experienced HIV positive women in a large antiretroviral therapy programme in South West Nigeria.
Study Design: Retrospective review of clinical records.
Place and Duration of Study: HIV Programme in College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria between January 2014 and December 2015.
Methodology: A review of the Pap smear results of 468 women attending the antiretroviral therapy (ART) clinic at the University College Hospital (UCH) Ibadan over a 2-year period was done. The cytological results were analyzed with biosocial variables. Level of significance was set at 95% confidence level.
Results: The mean age of the participants reviewed was 37.1+/- 8.7 years. The mean duration of ART among the participants was 19.5 (±14.0) months. The prevalence of any form of squamous Intraepithelial lesions (SIL) varied from 10.0% among those on ART for up to 12 months to 1.4% among those with more than 18 months of ART use (p=022) and polygamous relationship is significantly associated with dysplastic cervical lesions among this studied cohort (p=0.043)
Conclusion: While ART appears to have anti-Human Papillomavirus (HPV) activities as observed in the pattern of cervical dysplastic lesions, polygamy, a common family setting in this environment seems to promote development of SIL among these WLHIV. These findings require further studies to corroborate in the light of limitations of difficulty in disaggregating the duration of HIV diagnosis from the onset of treatment as most were already on treatment before the screening and failure of baseline Pap smear test at the entry point to determine the rate of progression.
Parkin DM, Bray F, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005; 55:74–108.
Parkin DM, Sitas F, Chirenje M, Stein L, Abratt R, Wabinga H. Part I: Cancer in Indigenous Africans-- Burden, distribution, and trends. Lancet Oncol. 2008;9(7):683-92.
Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. Globocan 2012 V1.0, Cancer incidence and mortality worldwide: IARC Cancerbase No. 11. 2013 [cited 2013 January 7, 2013]. Available: http://globocan.iarc.fr 8. Anorlu RI. Cervical Cancer: The Sub-Saharan African Perspective. Reprod Health Matters. 2008;16(32):41-9.
Petry KU, Wörmann B, Schneider A. Benefits and risks of cervical cancer screening. Oncol Res Treat. 2014; 37(suppl 3):48-57. DOI: 10.1159/000365059
Bosch FX, Lorincz A, Munoz N, Meijer CJ, Shah KV. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol. 2002;55:244–265.
Munoz N, Bosch FX, De Sanjose S, Tafur L, Izarzugaza I, Gili M et al. The causal link between HPV and invasive cervical cancer: A population based case-control study in Columbia and Spain. Int J Cancer. 1992;52:743–749.
Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervical cancer. J Pathol. 1999;189:12-19.
Ostor AG. Natural history of cervical intraepithelial neoplasia: A critical review. Int J Gynecol Pathol. 1993;12:186–192.
Adewole IF, Benedet JL,Crain BT, Follen M. Evolving a strategic approach to cervical cancer control in Africa. Gynecol Oncol. 2005;99:209–12.
Kapiga SH, Msamanga GI, Siegelman D, Nwakyoma H, Fawzi WW, Hunter DJ. Risk factors for cervical squamous intraepithelial lesions among HIV-1 seropositive women in dares salam; Tanzania, int. J Gynecol Obstet. 1999; 67(2):87-94
Adeyi O, Kanki P, Odutolu O. AIDS in Nigeria: A Nation on the threshold. Harvard University press; 2006.
Maiman M, Fruchter RG, Clark M. Cervical cancer as an AIDS-defining illness. J Obstetrics and Gynecology.1997;89:76-80.
Bower Mark, Mazhar Danish, Stebbing Justin. Should cervical cancer be an acquired immunodeficiency syndrome –defining cancer? Journal of Clinical Oncology 2006;24(16):2417-2419.
Denny L, Boa R, Williamson AL, Allan B, Hardie D, Stan R, Myer L. Human papillomavirus infection and cervical disease in human immunodeficiency virus-1-infected women. Obstet Gynecol. 2008; 111:1380–1387.
Ellerbrock TV, Chiasson MA, Bush TJ, Sun XW, Sawo D, Brudney K, et al. Incidence of cervical squamous intraepithelial lesions in HIV-infected women. JAMA. 2000; 283:1031–1037.
Bower Mark, Mazhar Danish, Stebbing Justin. Should cervical cancer be an Acquired Immunodeficiency Syndrome – Defining cancer? Journal of Clinical Oncology. 2006;24(16):2417–2419.
Cubie HA, Seagar AL, Beattie GJ, Monahgan S, Williams AR. A longitudinal study of HPV detection and cervical pathology in HIV infected women. Sex Transm Infect. 2000;76:257–261.
Wright TC Jr, Ellerbrock TV, Chiasson MA, Van Devanter N, Sun XW. Cervical intraepithelial neoplasia in women infected with human immunodeficiency virus: prevalence, risk factors, and validity of Papanicolaou smears. New York Cervical Disease Study. Obstet Gynecol. 1994;84: 591–597.
Adam Y, Van Gelderen CJ, De Bruyn G, McLntyre JA, Turton DA, Martinson NA. Predictors of persistent cytologic abnormalities after treatment of cervical intraepithelial neoplasia in Soweto, South Africa: A cohort study in a HIV high prevalence population. BMC Cancer. 2008;8:211.
Ramos MC, Pizarro De Lorenzo BH, Michelin MA, Murta EF. High-grade cervical intraepithelial neoplasia, human papillomavirus and factors connected with recurrence following surgical treatment. Clin Exp Obstet Gynecol. 2008;35:242– 247.
Adewuyi SA. Cervical cancer in HIV Seropositive patients. Annals of African Medicine. 2007;6(1):41–42.
Agboeze J, Umeora O, Ozumba B, Onoh R, Ezeonu P, Edegbe F. Prevalence and pattern of abnormal cervical smear among women infected with HIV in Abakaliki, Nigeria. Afr J Med Health Sci. 2015;14:92-5
Anorlu R, Igwillo C, Akanmu AA, et al. Prevalence of abnormal cervical smears among patients with HIV in Lagos. Asian Pac J Cancer Prev. 2011;12:647.
Dim CC, Ezegwui HU, Ikeme AC, Nwagha UI, Onyedum CC. Prevalence of cervical squamous intraepithelial lesions among HIV-positive women in Enugu, South-eastern Nigeria. J Obstet Gynaecol. 2011;31:759–762.
Ugboaja JO, Oguejiofor CO, Obi BN. Sociodemographic determinants of abnormal cervical cytology among HIV positive women in Nnewi, Nigeria. Int J Med Med Sci. 2017;9:119–125.
Agaba PA, Thacher TD, Ekwempu CC, Idoko JA. Cervical dysplasia in Nigerian women infected with HIV. Int J Gynaecol Obstet. 2009; 1072:99-102.
Lawal I, Agida TE, Offiong, RA, Oluwole PO. Cervical cytology among HIV positive and HIV negative women in a tertiary Hospital in North Central Nigeria: A comparative study. Ann Med Health Sci Res. 2017;7:308–11
Chama CM, Nggada H, Gashau W. Cervical dysplasia in HIV infected women in Maiduguri, Nigeria. J Obstet Gynaecol. 2005;25:2868
Muhammad Z, Usman IH, Datti ZA, et al. Incidence and risk factors of cervical dysplasia among HIV positive and Negative women in AKTH, Nigeria. Sahel Med J. 2017;20:160–7.
Ezechi OC, Ostergren PO, Nwaokorie FO, et al.. The burden, distribution and risk factors for cervical oncogenic human papilloma virus infection in HIV positive Nigerian women. Virol J. 2014;11:5. 1186/1743-422X-11-
Swende TZ, Ngwan SD, Swende LT. Prevalence and risk factors for cervical squamous intraepithelial lesions among women infected with HIV-1 in Makurdi, Nigeria. Int J) Women’s Health. 2012; 4:55-60.
Ogu, Cornelius Osinachi et al. Prevalence and risk factors of cervical dysplasia among human immunodeficiency virus sero-positive females on highly active antiretroviral therapy in Enugu, Southeastern, Nigeria. Asian Pacific Journal of Cancer Prevention: APJCP vol. 20, 10 2987-2994. 1 Oct. 2019. DOI:10.31557/APJCP.2019.20.10.2987),
De Vuyst H, Mugo NR, Chung MH, et al.. Prevalence and determinants of human papillomavirus infection and cervical lesions in HIV-positive women in Kenya. Br J Cancer. 2012;107:1624–1630. Available:10.1038/bjc.2012.441
McKenzie KP, Rogers RK, Njoroge JW, et al. Cervical squamous intraepithelial lesions among HIV-positive women on antiretroviral therapy in Kenya. Curr HIV Res. 2011;9: 180–185. Available:10.2174/157016211795945214
Huchko MJ, Leslie H, Sneden J, et al. Risk factors for cervical precancer detection among previously unscreened HIV-infected women in western Kenya. Int J Cancer. 2014;134:740–745. 1002/ijc.28401
Mogtomo ML, Malieugoue LC, Djiepgang C, et al. Incidence of cervical disease associated to HPV in human immunodeficiency infected women under highly active antiretroviral therapy. Infect Agent Cancer. 2009;4:9. DOI:10.1186/1750-9378-4-9
Kim SC, Messing S, Shah K, Luque AE. Effect of highly active antiretroviral therapy (HAART) and menopause on risk of progression of cervical dysplasia in human immune-deficiency virus- (HIV-) infected women. Infect Dis Obstet Gynecol. 2013; 2013:784718.
Heard I, Tassie J-M, Kazatchkine MD, Orth G. Highly active antiretroviral therapy enhances regression of cervical intraepithelial neoplasia in HIV-seropositive women. AIDS. 2002;16(13):1799–1802.
World Health Organization. Geneva: WHO; 1996. The World health report: Fighting disease, fostering development/report of the Director- General; 1996. Available:http://www.who.int/iris/handle/10665/36848 . [accessed on December 28, 2020].
Anand Narain Srivastava, Jata Shankar Misra, Shruti Srivastava, Bhudav C. Das, and Shilpi Gupta. Cervical cancer screening in rural India: Status & current concepts. Indian J Med Res. 2018;148(6): 687–696.