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APHA Scientific Session and Event Listing

Recorded presentation

Jennifer R. Moodley¹, M. Hoffman¹, H. Carrara¹, B. Allan², D. Cooper¹, L. Rosenberg³, L. Denny⁴, S. Shapiro¹, and AL Williamson². (1) Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa, 27 21 406 6504, jmoodley@cormack.uct.ac.za, (2) University of Cape Town, Institute of Infectious Disease and Molecular Medicine, Anzio Road, Cape Town, South Africa, (3) Slone Epidemiology Center, Boston University, 1010 Commonwealth Avenue, Boston, MA 02215-1201, (4) Department of Obstetrics and Gynaecology, University of Cape Town, Anzio Road, Cape Town, South Africa

Background: Cervical cancer and infection with human immunodeficiency virus (HIV) are both major public health problems in South Africa. The aim of this study was to determine the prevalence and risk of cervical pre-cancer and cancer among HIV positive women in South Africa.

Methods: The study was conducted in the Western Cape (South Africa), from January 1998 to December 2001. Data were derived from a case-control study that examined the association between hormonal contraceptives and invasive cervical cancer. There were 486 women with invasive cervical cancer, 103 control women with atypical squamous cells of undetermined significance (ASCUS), 53 with low-grade squamous intraepithelial lesions (LSIL), 40 with high-grade squamous intraepithelial lesions (HSIL) and 1159 with normal cytology. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multiple logistic regression.

Results: The adjusted odds ratios were: 4.4 [95% CI 2.3 – 8.4] for ASCUS, 7.4 (3.5 – 15.7) for LSIL, 5.8 (2.4 – 13.6) for HSIL and 2.0 (1.2 – 3.2) for invasive cervical cancer. HIV positive women were 5 times more likely to have high risk human papillomavirus infection (HPV) present compared to HIV negative women [OR 4.6 (95 % CI 2.8 – 7.5)]. Women infected with both HIV and HPV had a more than 40 fold higher risk of SIL than women infected with neither of these viruses.

Conclusions: Our findings underscore the importance of developing locally relevant screening and management guidelines for HIV positive women in South Africa.

Learning Objectives: At the end of this session, participants will

• Be able to describe the risk of cervical pre-cancer and cancer among HIV positive women in South Africa.
• Recognize the importance of developing feasible cervical cancer screening guidelines for HIV positive women in developing countries

Keywords: Cervical Cancer, HIV/AIDS

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation