Public health approach to prevent cervical cancer in HIV-infected women in Kenya: Issues to consider in the design of prevention programs

Abstract

Women living with HIV in Africa are at increased risk to be co-infected with Human Papilloma Virus (HPV), persistent high risk (HR) HPV infection and bacterial vaginosis (BV), which compounds HPV persistence, thereby increasing the risk for cervical dysplasia. New guidance from WHO in 2014 advocating for a “screen and treat” approach in resource poor settings is becoming a more widely recommended screening tool for cervical cancer prevention programs in such contexts. This review article summarizes the risk factors to be considered when designing a primary and secondary cervical prevention program in a post-vaccination era for HIV-infected women in Kenya.This review article is based on our prior research on the epidemiology of pHR/HR-HPV genotypes in HIV-infected women and CIN 2 + in Kenya and other sub-Saharan contexts. In order to contextualize the findings, a literature search was carried out in March 2017 by means of four electronic databases: PUBMED, EMBASE, SCOPUS, and PROQUEST.Risk factors for potential (pHR)/HR HPV acquisition, including CD4 count, HAART initiation, Female Sex Worker status (FSW) and BV need to be considered. Furthermore, there may be risk factors for abnormal cytology, including FSW status, multiple potential (p)HR/HR HPV genotypes, which may require that HIV-infected women be subjected to screening at more frequent intervals than the three year recommended by the WHO. The quadruple synergistic interaction between HIV, HPV and BV and its related cervicitis may need to be reflected within a larger prevention framework at the community level. The opportunities brought forth by the roll out of HAART could lead to task shifting of HIV-HPV-BV care to nurses, which may increase access in poorly-served areas.

A Framework for Cervical Cancer Elimination in Low-and-Middle-Income Countries: A Scoping Review and Roadmap for Interventions and Research Priorities

“…HIV presents challenges to accurate screening for women. There are more false-positive rates with VIA among women living with HIV than women without HIV ( 199 , 200 ), likely due to the higher rates of cervical inflammation ( 201 , 202 ). While HPV testing is an effective screening method among women living with HIV, it could lead to overestimates of cervical lesion prevalence and overtreatment ( 203 ).…”

Association Between Hormonal Contraceptives and Cervical Neoplasia in Local Population of Khyber Pakhtunkhwa

“…In our country, COCPS and injectables are the two most popular options. The chance of developing cervical cancer increases after five years or more of oral contraceptive use [13]. The death rate from cervical cancer in the industrialized world has decreased by more than 70 percent thanks to the widespread use of the Pap smear as a screening test that can detect dyskaryosis with great sensitivity.…”

Network modeling suggests HIV infection phenocopies PI3K-AKT pathway mutations to enhance HPV-associated cervical cancer

“…Women living with HIV have increased risk of persistent HR-HPV infection, 15,16 a six times higher risk of developing cervical cancer (Fig. 1(A); 17 ), higher treatment failure rates, 18 elevated progression of pre-cancerous lesions to ICC, 19 earlier onset of cancer 2 and reduced survival rates 20 compared to those without HIV.…”