AEGiS-11IAC: The role of HIV-1 and human papillomavirus (HPV) in the development of cervical cancer in Nairobi, Kenya.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

The role of HIV-1 and human papillomavirus (HPV) in the development of cervical cancer in Nairobi, Kenya.

Int Conf AIDS 1996 Jul 7-12; 11:445 (abstract no. Pub.B.1047)
Kidula N, Tyndall MW, Muchiri L, Sande J, Ndinya-Achola JO, Temmerman M; Kenya Medical Women's Association, Nairobi, Kenya.

OBJECTIVES: Cervical cancer is the leading cause of cancer deaths among women in East Africa. HPV is now recognized as an etiologic agent in the development of cervical cancer, while the role of HIV-1 remains unclear. This study was conducted to determine the prevalence of HIV-1, HPV and cervical pathology, and to measure the associations between them.

METHODS: A cross-sectional study at an urban family planning clinic was conducted between May and December 1994. In addition to routine services, all clients were eligible to participate in a program for cervical cancer screening which included a physical examination, a PAP smear and a cervical brush specimen for HPV detection using polymerase chain reaction (PCR). Serum for HIV-1 and syphilis was also collected. Follow-up was arranged after 7 days to discuss test results and manage cervical lesions.

RESULTS: Among the 520 participants the prevalence of HIV-1 was 10.2%. Cervical pathology was detected in 63 (12.1%), including 29 with CIN I, 18 with CIN II, 4 with CIN III and 12 with carcinoma in-situ or invasive disease. HPV was detected in 87 (16.7%), including 65 (75%) with malignant serotypes (16, 18, 31 or 33), 7 (8%) with nonmalignant serotypes (6 or 11) and 15 (18%) which could not be serotyped. The detection of HPV was associated with HIV-1 (Odds Ratio 4.6, 95% Confidence Interval 2.5-8.4). CIN was strongly associated with HPV (OR 18.3, 95% CI 10.0-33.6), and weakly associated with HIV-1 (OR 3.1, 95% CI 1.6-6.0). A logistic regression model which included HIV-1, HPV, as well as demographic and behavioral variables, showed a persistently strong association between HPV and CIN (OR 15.9, 95% CI 8.5-29.9), but no independent association between HIV-1 and CIN.

CONCLUSIONS: In this population of lower risk women the prevalence of HIV-1, HPV and CIN were disturbingly high. In the adjusted analysis, the detection of HPV was a strong predictor of CIN, while HIV-1 was not an independent predictor of CIN. Prospective studies are required to determine the role of HIV-1 in both the acquisition of HPV and the progression of CIN.

Keywords: AEGIS, Papillomavirus, Human, Cervix Neoplasms, Cervical Intraepithelial Neoplasia, HIV-1, Vaginal Smears, Cervix Diseases, Polymerase Chain Reaction, Carcinoma in Situ, Odds Ratio, Prevalence, Cross-Sectional Studies, Kenya, Prospective Studies, Africa, Human, Female, ICA11

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PubB1047