AEGiS-13IAC: Association between HIV and cervical dysplasia in Nairobi-Kenya.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Association between HIV and cervical dysplasia in Nairobi-Kenya.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrB234)

De Vuyst H, Claeys P, Njirv S, Bwayo J, Temmerman M
H. De Vuyst, University of Nairobi, Microbiology, PO Box 19676, Nairobi, Kenya, Tel.: +254 2 751 751, Fax: +254 2 726 626, E-mail: hdvuyst@iconnect.co.ke

BACKGROUND: The association between HIV and cervical dysplasia is well documented in Western countries. Data for developing countries, however, are scarce and sometimes conflicting. As part of an ongoing study on diagnostic methods for STDs and cervical dysplasia (CeDys) in a family planning clinic (FPC), we examined the association between HIV and cervical lesions.

METHODS: Women attending the FPC were invited for screening for STDs and cervical lesions using PAP-smear, HPV testing, colposcopy, cervicography and VIA. Biopsy and/or curettage was performed in case of abnormal VIA, PAP-smear or colposcopy. Biopsy/curettage results were considered as the gold standard for the diagnosis of dysplasia or cervical cancer (CeCa).

RESULTS: We present cervical screening preliminary results on 480 cases. The mean age was 35 years (20-83). We found 23 (4.8%) cases of low grade squamous intraepithelial lesions (LSIL), 34 (7%) cases of high grade SIL (HSIL) and 3 (0.6%) women with invasive cancer. Fifty nine (12%) women were HIV seropositive, 421 (88%) HIV seronegative. In the HIV+ group, we found 6 LSIL (10%), compared to 17 LSIL (4%) in the HIV- group (p = .05; OR 2.7; 95% CI 0.83-7.54); 10 HIV+ women (17%) had a HSIL as compared to 24 (6.4%) in the HIV- group (p = .0047; OR 3.4; 95% CI 1.34-7.78). The 3 cases of macroinvasive cervical cancer were HIV seronegative.

CONCLUSIONS: These preliminary results show a correlation between high grade cervical lesions and HIV infection and underscore the contribution of HIV infection to the already high burden of cervical cancer in poor resource regions. Nevertheless, national screening programmes for cervical cancer are almost non-existent in most African countries because of logistic and financial constraints. Further operational research is needed to identify affordable and reliable screening- and treatment programmes for cervical cancer, especially in populations with high HIV prevalence. Alternative screening techniques might help poor resource countries to develop sustainable screening campaigns.

Keywords: AEGIS, Cervix Dysplasia, Cervical Intraepithelial Neoplasia, Vaginal Smears, Cervix Neoplasms, HIV Infections, Papillomavirus, Human, Colposcopy, HIV Seropositivity, Cervix Diseases, Prevalence, Cervix Uteri, Mass Screening, Biopsy, Kenya, Human, Female
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MoOrB234