Download Cervical Cancer: Experiences from a Cohort of HIV Infected Women

Cervical Cancer:
Experiences from a Cohort
of HIV-infected Women
Pascoe M, Magure T, Mudhokwani P et al
Abstract: MOAB0202
Presentation Outline
• Background
• Objectives
• Methodology
• Results
• Conclusion and recommendations
Background
• Cervical carcinoma the most common malignancy in Zimbabwean
women, is preventable
• Women living with HIV (WLWHIV) have higher prevalence of Human
Papillomavirus (HPV) infection, & multiple subtypes including
oncogenic HPV
• They are at risk of higher grade lesions, higher rates of recurrent &
persistent cervical disease & invasive cervical cancer (ICC)
• Primary prevention with HPV vaccination is possible
• Secondary prevention includes screening & treatment of early lesions
Objectives
This study was done in order to:
• Describe the prevalence of cervical disease in a cohort of
women receiving care for HIV infection
• Provide evidence to support the need for cervical cancer
screening for WLWHIV in Zimbabwe
Methodology
• Newlands Clinic provides comprehensive care & treatment for 5500
patients (60% female)
• Cervical cancer screening using visual inspection with acetic acid (VIA)
method introduced for sexually active females
• VIA & appropriate treatment with either cryotherapy or loop
electrosurgical excision procedure (LEEP)
• A record review of women undergoing initial cervical screening from
Jan 2011 to Dec 2014
• Assessment of women with VIA+ve lesions at initial screening (IS) &
histological analysis of 326 biopsies was done
Results
Percentage of Women with
VIA Positive Lesions at IS
Year
34.9% (314/899)
2011
32.4% (439/1357)
2012
31.0% (126/406)
2013
33.0% (110/333)
2014
The mean was 32.8 %
Histological Diagnosis
Histological diagnosis of 326 biopsy specimens obtained during LEEP
• CIN I - 15.7%
• CIN II - 30.0%
• CIN III - 29.4%
• ICC - 2%
Conclusions & Recommendations
• Cervical disease (defined by VIA+ve) was present in 1/3 of women
at initial screening
• Histology of 326 biopsy specimens showed moderate to severe
dysplasia (CIN II & III) in 59.4% & ICC in 2%
• These data illustrate the high prevalence of cervical disease &
support the need for cervical cancer screening as a mandatory
component of care for all WLWHIV
• The urgency for HPV vaccination as primary prevention strategy is
highlighted
Thank you for your attention