Gynecologic Cytopathology

Gupta R.a· Hussain S.b· Hariprasad R.c· Dhanasekaran K.c· Verma S.d· Agarwal V.e· Sandeepa· Parveen S.a· Kaur A.f· Verma C.P.g· Amitac· Dwivedi R.c· Singh S.h· Gupta S.a

Author affiliations

aDivision of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
bMolecular Biology Group, ICMR-National Institute of Cancer Prevention and Research, Noida, India
cDivision of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
dMedical Officer and Incharge, ART Centre, District Hospital (MMG Hospital), Ghaziabad, India
eDepartment of Gynecology and Obstetrics, Dr Bhim Rao Ambedkar Multispecialty Hospital, Noida, India
fIndependent Researcher, Punjab, India
gDivision of Preventive Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
hDepartment of Pathology, Hindu Rao Hospital, Delhi, India

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Article / Publication Details

First-Page Preview

Received: January 09, 2022
Accepted: May 21, 2022
Published online: June 27, 2022

Number of Print Pages: 11
Number of Figures: 3
Number of Tables: 4

ISSN: 0001-5547 (Print)
eISSN: 1938-2650 (Online)

For additional information: https://www.karger.com/ACY

Abstract

Introduction: Women living with HIV (WLHIV) are at an increased risk of developing cervical precancerous lesions and cervical human papillomavirus (HPV) infection. This study aimed at evaluating the prevalence of cervical lesions and high-risk HPV (HR-HPV) infection in WLHIV in comparison to the HIV-negative women undergoing opportunistic screening. In addition, these findings among WLHIV were correlated with the clinic-demographic factors. Methods: A cross-sectional study was conducted among WLHIVs at a tertiary hospital and linked antiretroviral therapy (ART) center, while HIV-negative women were recruited from the health promotion clinic at our institute. With informed consent, a semi-structured questionnaire was filled on demographic and epidemiological parameters. Conventional cervical smears and samples for HPV DNA detection by HC2 high-risk HPV DNA test were collected in all participants. Cervical smears were reported using the Bethesda system 2014. Appropriate statistical analysis was performed for bivariate and multivariate logistic regression analysis for comparison between WLHIV and HIV-negative women and for correlation of abnormal cervical cytology and HR-HPV infection among WLHIVs. Results: The clinic-demographic characteristics of WLHIVs and HIV-negative women were similar. On cytology, the prevalence of cervical cytological abnormalities were significantly higher (p < 0.001) among WLHIVs (14.1%) compared to HIV-negative women (3.1%). High-grade lesions were seen in 3.7% of WLHIVs, while no high-grade lesions were detected in HIV-negative women. Cervical HR-HPV infection was also significantly higher (p < 0.001) in WLHIVs (28.9%) than HIV-negative women (9.3%). Cervical precancerous lesions in WLHIVs showed positive association with current sexually transmitted infection (STI), multiple sexual partners, tobacco use, and CD4 count less than 200/µL, while cervical HPV was positively associated with current STI, tobacco use, CD4 count less than 200/µL and negatively with ART intake. On multivariate logistic regression, cervical cytological abnormalities showed a significant association with multiple sexual partners (p < 0.001), while cervical HR-HPV infection was positively associated with current STI (p = 0.01), nadir CD4 count <200/µL (p = 0.004), abnormal cervical cytology (p = 0.002) and negatively with ART intake (p = 0.03). Conclusion: Women living with HIV have a significantly higher prevalence of cervical precancerous lesions and HR-HPV infection compared to the general population. Considering the lack of an organized population-based cervical cancer screening program in many low-resource countries like ours, specific focus on screening this highly vulnerable population to reduce the morbidity and mortality due to cervical cancer is imperative.

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References Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–49. Human Papillomavirus and Related Cancers. Summary Report Update. India. WHO/ICO HPV Information Center; 2021. Available from: http://www.hpvcentre.net/statistics/reports/IND.pdf (accessed December 24, 2021). Isaakidis P, Pimple S, Varghese B, Khan S, Mansoor H, Ladomirska J, et al. HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mumbai, India: 12-month follow-up. Int J Womens Health. 2013;5:487–94. Mane A, Nirmalkar A, Risbud AR, Vermund SH, Mehendale SM, Sahasrabuddhe VV. HPV genotype distribution in cervical intraepithelial neoplasia among HIV-infected women in Pune, India. PLoS One. 2012;7(6):e38731. Branca M, Garbuglia AR, Benedetto A, Cappiello T, Leoncini L, Migliore G, et al. Factors predicting the persistence of genital human papillomavirus infections and PAP smear abnormality in HIV-positive and HIV-negative women during prospective follow-up. Int J STD AIDS. 2003;14:417–25. Centers for Disease Control and Prevention. 1993 sexually transmitted diseases treatment guidelines. Centers for disease control and prevention. MMWR Recomm Rep. 1993;42(RR-14):1–102. Bhatla N, Singhal S, Saraiya U, Srivastava S, Bhalerao S, Shamsunder S, et al. Screening and management of preinvasive lesions of the cervix: good clinical practice recommendations from the federation of obstetrics and gynaecologic societies of india (FOGSI). J Obstet Gynaecol Res. 2020;46(2):201–14. World Health Organization. Cervical cancer elimination initiative; 2020. Available from: https://www.who.int/initiatives/cervical-cancer-elimination-initiative (accessed on December 24, 2021). Joshi S, Sankaranarayanan R, Muwonge R, Kulkarni V, Somanathan T, Divate U. Screening of cervical neoplasia in HIV-infected women in India. AIDS. 2013;27(4):607–15. Nayar R, Wilbur DC. The Bethesda system for reporting cervical cytology: definitions, criteria, and explanatory notes. 3rd ed. Switzerland: Springer; 2015. Birdsong GG, Walker JW. Gynecologic cytology-histology correlation guideline. J Am Soc Cytopathol. 2017;6(2):VIII–XIII. From the Centers for Disease Control and Prevention. From the centers for disease control and prevention. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. JAMA. 1993;269(6):729–30. Stelzle D, Tanaka LF, Lee KK, Ibrahim Khalil AI, Baussano I, Shah ASV, et al. Estimates of the global burden of cervical cancer associated with HIV. Lancet Glob Health. 2021;9(2):e161–9. Chakravarty J, Chourasia A, Thakur M, Singh AK, Sundar S, Agrawal NR. Prevalence of human papillomavirus infection & cervical abnormalities in HIV-positive women in eastern India. Indian J Med Res. 2016;143(1):79–86. Branca M, Migliore G, Giuliani M, Leoncini L, Ippolito G, Cappiello G, Garbuglia AR, et al. Squamous intraepithelial lesions (SILs) and HPV associated changes in HIV infected women or at risk of HIV. DIANAIDS Cooperative Study Group. Eur J Gynaecol Oncol. 2000;21(2):155–9. Sarkar K, Pal R, Bal B, Saha B, Bhattacharya S, Sengupta S, et al. Oncogenic HPV among HIV infected female population in West Bengal, India. BMC Infect Dis. 2011;11:72. Peedicayil A, Thiyagarajan K, Gnanamony M, Pulimood SA, Jeyaseelan V, Kannangai R, et al. Prevalence and risk factors for human papillomavirus and cervical intraepithelial neoplasia among HIV-positive women at a tertiary level hospital in India. J Low Genit Tract Dis. 2009;13(3):159–64. Liu G, Sharma M, Tan N, Barnabas RV. HIV-positive women have higher risk of human papilloma virus infection, precancerous lesions, and cervical cancer. AIDS. 2018;32(6):795–808. Delmas MC, Larsen C, van Benthem B, Hamers FF, Bergeron C, Poveda JD, et al. Cervical squamous intraepithelial lesions in HIV-infected women: prevalence, incidence and regression. European Study Group on Natural History of HIV Infection in Women. AIDS. 2000;14(12):1775–84. Weldegebreal F, Worku T. Precancerous cervical lesion among HIV-positive women in Sub-Saharan Africa: a systematic review and meta-analysis. Cancer Control. 2019;26(1):1073274819845872. Heard I, Tassie JM, Kazatchkine MD, Orth G. Highly active antiretroviral therapy enhances regression of cervical intraepithelial neoplasia in HIV-seropositive women. AIDS. 2002;16(13):1799–802. Mbulawa ZZ, Marais DJ, Johnson LF, Coetzee D, Williamson AL. Impact of human immunodeficiency virus on the natural history of human papillomavirus genital infection in South African men and women. J Infect Dis. 2012;206(1):15–27. Paramsothy P, Jamieson DJ, Heilig CM, Schuman PC, Klein RS, Shah KV, et al. The effect of highly active antiretroviral therapy on human papillomavirus clearance and cervical cytology. Obstet Gynecol. 2009;113(1):26–31. Aranda S, Berkley S, Cowal S, Dybul M, Evans T, Iversen K, et al. Ending cervical cancer: a call to action. Int J Gynaecol Obstet. 2017;138(Suppl 1):4–6. Article / Publication Details

First-Page Preview

Received: January 09, 2022
Accepted: May 21, 2022
Published online: June 27, 2022

Number of Print Pages: 11
Number of Figures: 3
Number of Tables: 4

ISSN: 0001-5547 (Print)
eISSN: 1938-2650 (Online)

For additional information: https://www.karger.com/ACY

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