Squamous intraepithelial lesions of the cervix, invasive cervical carcinoma, and immunosuppression induced by human immunodeficiency virus in africa

Ruche, Guy La; Ramón, Rosa; Mensah-Ado, Isabelle; Bergeron, Christine; Diomandé, Mohamed; Sylla-Koko, F; Ehouman, A.; Toure-Coulibaly, K.; Welffens‐Ekra, Christiane; Dabis, François

doi:10.1002/(sici)1097-0142(19980615)82:12<2401::aid-cncr14>3.3.co;2-h

Cited by 44 publications

(28 citation statements)

References 16 publications

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“…Multiple partners and HIV infection are factors highly associated with higher rates HPV infections, persistence and progression to SIL (Palefsky et al, 2001;Massad, 1999). A similar trend, however insignificant was seen with single/widowed developing HGL compared to married women in a West African study (La Ruche et al, 1998). Despite the significant association between SIL and number of life time partners noted in our study, a report in Dar es Salaam, Tanzania could not find this association (Kapiga et al, 1999).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and severity of cervical squamous intraepithelial lesion in a tertiary hospital in northern Tanzania

Obure

Olola²,

Swai³

et al. 2010

Tanzania J Hlth Res

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Cervical cancer is the second most common cancer in women worldwide and the leading cause of cancer deaths in Tanzanian women. Prevention of cervical cancer relies on the detection and treatment of Squamous Intraepithelial Lesion (SIL), a premalignant disease stage. Worldwide there are overwhelming reports associating SIL and HIV infection, however in Tanzania such reports are limited. A cross-sectional hospital-based descriptive study was conducted to determine the prevalence and severity of SIL in 234 HIV seropositive and seronegative women aged 18-68 years old at Kilimanjaro Christian Medical Centre in northern Tanzania. A structured questionnaire was used to collect sociodemographic data. In addition, blood was collected for rapid HIV antibody testing and CD4+ T-lymphocyte counts to associate with prevalence and severity of SIL from the cervical smear collections. A total of 214 subjects had smear results regarded as valid for interpretation, of which 46.3% were HIV seropositive. Overall rate of SIL was 17%. Proportion of SIL among HIV seropositive subjects was 32% versus 4% in seronegative subjects (OR=13.3, 95% CI=4.2-46.4). Low CD4+ Tlymphocyte cell count was associated with higher prevalence of SIL (P=0.001). The relationship between CD4+ T-lymphocyte cell counts and the severity of cervical SIL was significant (P=0.007). Marital status and number of lifetime sex partners were risk factors significantly associated with SIL (P=0.004 and 0.005, respectively). SIL was not associated with age, education level, parity or age at sex debut. The prevalence and severity of cervical SIL was significantly associated with HIV infection and immunologic disease progression. These findings underscore the need for HIV screening among women with SIL, and the need for cervical cancer screening in HIV-infected women. Marital status and number of lifetime sex partners were significant risk factors associated with SIL. _______________________________________________________________________________________

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Section: Discussionmentioning

confidence: 99%

Prevalence and severity of cervical squamous intraepithelial lesion in a tertiary hospital in northern Tanzania

Obure

Olola²,

Swai³

et al. 2010

Tanzania J Hlth Res

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“…7 Other investigators have reported that there was no increased risk of ICC based on HIV status alone. 8,9 La Ruche and colleagues noted similar rates of ICC among HIV-positive and HIV-negative women who were seen at gynecologic clinics in Africa. 8 An increased rate of ICC also was not observed among women in the Women's Interagency HIV Study.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 La Ruche and colleagues noted similar rates of ICC among HIV-positive and HIV-negative women who were seen at gynecologic clinics in Africa. 8 An increased rate of ICC also was not observed among women in the Women's Interagency HIV Study. 9 Combining 3 large studies, the rate of cervical cancer in HIV-positive women was 0.7% (33 of 4714 women) compared with 0.6% (250 of 39,953 women) in HIV-negative women.…”

Section: Discussionmentioning

confidence: 99%

Cervical cancer in patients infected with the human immunodeficiency virus

Leitao

White²,

Cracchiolo³

2008

Cancer

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BACKGROUND.The objective of this study was to compare the human immunodeficiency virus (HIV) viral load (VL) and CD4 counts in patients infected with HIV with and without cervical cancer. The authors hypothesized that HIV‐positive women with cervical cancer would have a greater risk of immune suppression.METHODS.A case–control study was conducted that included all HIV‐positive patients who were seen at the authors' institution from January 1, 1995 to April 20, 2006 with invasive cervical cancer (cases) and without invasive cervical cancer (controls). Patients were included only if they had a CD4 count recorded <6 months before or <3 months after their diagnosis of invasive cervical cancer (cases) or at their last gynecologic examination (controls). Controls were matched to cases on a 4:1 ratio according to current smoking history. Patients were considered immunocompetent if they had both a CD4 count >200 cells/μL and a VL <10,000 copies/mL.RESULTS.In total, 15 cases and 60 controls were identified. The median CD4 count for cases was 208 cells/μL (range, 18‐1102 cells/μL) compared with 445 cells/μL (range, 20‐1201 cells/μL) for controls (P = .03). The median VL was 16,918 copies/mL (range, 50‐214,915 copies/mL) for cases compared with 1430 copies/mL (range, 50‐571,000 copies/mL) for controls (P = .15). Only 1 of 14 cases (7%) was immunocompetent compared with 35 of 55 controls (64%; odds ratio, 0.04; 95% confidence interval, 0‐0.37; P < .001). This significance was maintained after adjusting for other factors (P = .002).CONCLUSIONS.Women with HIV who were diagnosed with invasive cervical cancer appeared to have a much greater degree of immunosuppression than women with HIV without invasive cervical cancer. Cancer 2008. © 2008 American Cancer Society.

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“…Its incidence has decreased in developed countries, where cervical screening is widespread. However, it remains common in less developed countries, where access to screening is limited, and is the leading cause of cancer death among women in Africa (1)(2)(3)(4). Exposures related to sexual and reproductive behavior play an important role in the etiology of cervical cancer.…”

Section: Introductionmentioning

confidence: 91%

“…Exposures related to sexual and reproductive behavior play an important role in the etiology of cervical cancer. Human papillomavirus (HPV), a sexually transmitted infection, is clearly established as a necessary agent in the development of cervical cancer (2,3,(5)(6)(7)(8)(9)(10). Other established risk factors include smoking, increasing parity, early age at first intercourse, multiple sexual partners, and infection with other sexually transmitted diseases (3,(5)(6)(7)11).…”

Section: Introductionmentioning

confidence: 99%

HIV Infection as a Risk Factor for Cervical Cancer and Cervical Intraepithelial Neoplasia in Senegal

Holmes

Hawes

Touré

et al. 2009

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Cervical cancer is the second leading cause of cancer mortality in women worldwide, and the leading cause in Africa. There is uncertainty in the role of HIV infection as a risk factor for invasive and preinvasive cervical lesions, particularly in African populations. In a casecontrol study in Dakar, Senegal, we studied 150 women with invasive cervical cancer (ICC), 92 with cervical intraepithelial neoplasia (CIN) 2 or 3, 70 with CIN 1, and 515 control women. We used logistic regression analysis to estimate associations between HIV-1 and HIV-2 infection and the risk of cervical neoplasia. We found large increases in the risk of ICC and CIN 2-3, but not of CIN 1, associated with the presence of either HIV-1 or HIV-2 infection (odds ratios of 6.5 and 10.4 for ICC and CIN 2-3). Our analysis thus shows increases in the risk of both advanced and early cervical pathology associated with HIV infection in an African population.

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Squamous intraepithelial lesions of the cervix, invasive cervical carcinoma, and immunosuppression induced by human immunodeficiency virus in africa

Cited by 44 publications

References 16 publications

Prevalence and severity of cervical squamous intraepithelial lesion in a tertiary hospital in northern Tanzania

Prevalence and severity of cervical squamous intraepithelial lesion in a tertiary hospital in northern Tanzania

Cervical cancer in patients infected with the human immunodeficiency virus

HIV Infection as a Risk Factor for Cervical Cancer and Cervical Intraepithelial Neoplasia in Senegal

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