Impact of HIV infection on invasive cervical cancer in Kenyan women

Gichangi, Peter; Bwayo, Job J.; Estambale, Benson B.; Vuyst, Hugo De; Ojwang, S. B. O.; Rogo, Khama; Abwao, H. O.; Temmerman, Marleen

doi:10.1097/00002030-200309050-00015

Cited by 56 publications

(50 citation statements)

References 28 publications

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“…6 HIV testing was performed using enzyme-linked immunosorbent assay (ELISA, Biochem Immuno Systems Kit, Montreal, Canada) and double ELISA (Biotech, Cambridge, Ireland) for confirmation. Exfoliated tumor cells were collected using a Cervex brush (Rovers Medical Devices, Oss, the Netherlands) and stored at 220°C in phosphate buffered saline.…”

Section: Methodsmentioning

confidence: 99%

Human papillomavirus types in women with invasive cervical carcinoma by HIV status in Kenya

Vuyst

Gichangi

Estambale

et al. 2007

Intl Journal of Cancer

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To evaluate the fraction of invasive cervical carcinoma (ICC) that could be prevented in HIV-infected women by vaccines currently available against human papillomavirus (HPV)16 and 18, we conducted a cross-sectional study in women with ICC in Nairobi, Kenya. Fifty-one HIV-positive women were frequency-matched by age to 153 HIV-negative women. Cervical cells were tested for HPV DNA using polymerase chain reaction-based assays (SPF10-INNO-LiPA). Comparisons were adjusted for multiplicity of HPV types. As expected, multiple-type infections were much more frequent in HIV-positive (37.2%) than in HIV-negative (13.7%) women, but the distribution of HPV types was similar. HPV16 was detected in 41.2% versus 43.8% and HPV16 and/or 18 in 64.7% versus 60.1% of HIV-positive versus HIV-negative women, respectively. The only differences of borderline statistical significance were an excess of HPV52 (19.6% versus 5.2%) and a lack of HPV45 (7.8% versus 17.0%) in HIV-positive women compared to HIV-negative women, respectively. We have been able to assess an unprecedented number of ICCs in HIV-positive women, but as we did not know the age of HIV acquisition, we cannot exclude that it had occurred too late in life to affect the type of HPV involved in cervical carcinogenesis. However, if our findings were confirmed, they would suggest that the efficacy of current vaccines against HPV16 and 18 to prevent ICC is similar in HIV-positive and HIVnegative women, provided vaccination is administered before sexual debut, as recommended. ' 2007 Wiley-Liss, Inc.Key words: HIV; cervical cancer; human papillomavirus; polymerase chain reaction; AfricaThe main cause of invasive cervical carcinoma (ICC) is infection with high-risk human papillomavirus (HPV), most notably HPV16 and 18, which have been detected in approximately 70% of ICC in all world regions. 1 Newly developed vaccines have been shown to be highly efficacious in preventing infection with these HPV types and routine vaccination of adolescent women is now being recommended. 2 Women infected with HIV are at increased risk of HPV infection 3 and development of precancerous and cancerous lesions of the cervix. 4 Furthermore, a large systematic review of HIV-positive women with normal cytology, low-grade and high-grade intraepithelial lesions has shown that HPV16 is relatively under-represented when compared to HIV-negative women. 3 This difference has been attributed to the fact that clearance of HPV16 is less dependent on an individual's immune status than clearance of other high-risk types, as shown in HIV-positive women. 5 Information on HPV types in ICC has been reported, however, in only 14 HIV-positive women. 3 We have therefore carried out a comparison of the distribution of HPV types in ICC in women with and without HIV in Kenya, a country hit hard by the HIV epidemic (www.unaids.org/en/Regions_Countries/Countries/ kenya.asp). MethodsBetween January 2000 and March 2002, we identified and obtained informed consent from 367 women with ICC (i.e., 96% of those eligible) who pres...

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Section: Methodsmentioning

confidence: 99%

Human papillomavirus types in women with invasive cervical carcinoma by HIV status in Kenya

Vuyst

Gichangi

Estambale

et al. 2007

Intl Journal of Cancer

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“…10, 34 Gichangi et al in Kenya 10 found that young women under the age of 35 who had invasive cervical cancer were 2.6 times more likely to be HIVpositive than controls of similar age (35% vs. 17%, OR 2.6, p=0.043). Hawes et al in Senegal found invasive cervical cancer in 0.3% of HIVnegative women, compared with 1.9% in HIV-1 positive women (OR 6.7, 95% CI 2.1-21.7), 4.5% in HIV-2 positive women (OR 16.0, 95% CI 3.8-67.7) and 6.9% in dually-infected women (OR, 37.2; 95% CI 6.6-210).…”

Section: Biological Factorsmentioning

confidence: 99%

Cervical cancer: the sub-Saharan African perspective

Anorlu¹

2008

Reproductive Health Matters

266

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Cervical cancer is the second most common cancer in women worldwide and the leading cause of cancer deaths in developing countries. While incidence and mortality rates of cervical cancer have fallen significantly in developed countries, 83% of all new cases that occur annually and 85% of all deaths from the disease occur in developing countries. Cervical cancer is the most common cancer among women in sub-Saharan Africa. The incidence is on the increase in some countries. Knowledge and awareness of this disease on the continent are very poor and mortality still very high. Facilities for the prevention and treatment of cervical cancer are still very inadequate in many countries in the region. Governments in sub-Saharan Africa must recognise cervical cancer as a major public health concern and allocate appropriate resources for its prevention and treatment, and for research. Indeed, cervical cancer in this region must be accorded the same priority as HIV, malaria, tuberculosis and childhood immunisations.

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“…There has been no evidence of increased incidence of ICC with the use of regular screening and appropriate evaluation and treatment of abnormal Paps Massad et al 2009). Casecontrol or cross-sectional studies in various African countries, including Cote d'Ivoire, Tanzania, South Africa, Kenya and Senegal have found that ICC was associated with HIV infection (Adjorlolo-Johnson et al 2010;Kahesa et al 2008;Stein et al 2008;Hawes et al 2003;Gichangi et al 2003). However, studies evaluating the strength of association of HIV with cervical cancer among African women have shown conflicting results, possibly reflecting the competing risk of dying from other HIV-related conditions or other illnesses (Adjorlolo-Johnson et al 2010;.…”

Section: Invasive Cervical Cancer (Icc) In Hiv Diseasementioning

confidence: 99%