HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mumbai, India: 12-month follow-up

Abstract

BackgroundHIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.MethodsFrom May 2010 to October 2010, Médecins Sans Frontières and Tata Memorial Hospital Mumbai offered routine annual Pap smears and HPV DNA testing of women attending an antiretroviral therapy (ART) clinic and a 12-month follow-up. Women with abnormal test results were offered cervical biopsy and treatment, including treatment for sexually transmitted infections (STIs).ResultsNinety-five women were screened. Median age was 38 years (IQR: 33–41); median nadir CD4-count 143 cells/μL (IQR: 79–270); and median time on ART 23 months (IQR:10–41). HPV DNA was detected in 30/94 women (32%), and 18/94 (19%) showed either low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL) on Pap smear. Overall, >50% had cervical inflammatory reactions including STIs. Of the 43 women with a cervical biopsy, eight (8.4%) had CIN-1, five (5.3%) CIN-2, and two (2.1%) carcinoma in situ. All but one had HPV DNA detected (risk ratio: 11, 95% confidence interval: 3.3–34). By October 2011, 56 women had completed the 12-month follow-up and had been rescreened. No new cases of HPV infection/LSIL/HSIL were detected.ConclusionThe high prevalence of HPV infection, STIs, and cervical lesions among women attending an ART clinic demonstrates a need for routine screening. Simple, one-stop screening strategies are needed. The optimal screening interval, especially when resources are limited, needs to be determined.

Cervical HPV infection in Romanian women infected with HIV during early childhood

“…We found that the prevalence of genital HPV infection in the HIV-uninfected and HIV-infected women was similar to previously reported rates in Romania 3, 15, 16 , and similar to rates reported HIV-infected women in a multicenter European study 17 and other studies from limited resource countries 7, 18 . HIV infection in this group of Romanian women has had a different course in comparison to vertically infected children, with a natural history of 8–10 years of asymptomatic infection, similar to adults.…”

Cervical cytological abnormalities and human papilloma virus infection in women infected with HIV in Southern India

“…Pap smear abnormalities in HIV‐infected women have been reported from various studies in India to be varying from 6.3% to 19% . There was a higher prevalence of Pap smear abnormalities in our study of 27.5%.…”

“…In our study, the prevalence of HPV infection among HIV‐infected women was 57.7%. Studies done in India have found a varying prevalence of 26.4% to 56% . High‐risk HPV types are reportedly found in 37.3–59% of patients with HIV .…”

The Human papillomavirus among women living with Human Immunodeficiency Virus in Morocco A prospective cross-sectional study

“…This data corroborate previous reports [46,47]. However, this rate is much lower than the rates reported in sub-Saharan Africa, which ranged from 49.8% to 73% [48] and India (27.5%) [15].…”