Human Immunodeficiency Virus (HIV) related immunosuppression predisposes co-infection with Human Papillomavirus (HPV) and increases the risk of cervical intraepithelial neoplasia (CIN) and cervical cancer. Centers for Disease Control (CDC) has included invasive cervical carcinoma among the AIDS-defining conditions. India shares 25% of global burden of cervical cancer and a third large burden of HIV-infected women [1,2] who currently continue to live longer due to improved access to antiretroviral therapy. A cross-sectional study was performed to determine the prevalence of HPV infection, risk of cervical pre-cancer and clinical performance validation of Visual Inspection with Acetic Acid (VIA), Pap cytology and HPV tests among women living with HIV/AIDS in Mumbai, India.
309 HIV Positive women attending cervical cancer screening services in a tertiary care centre between 2009-12 were enrolled for cervical cancer screening using Visual inspection with acetic acid (VIA), Pap cytology and HPV testing. Total 291 HIV Positive women were included in the analysis. 18 were excluded from analysis for incomplete investigations. Screen positive women by either of the screening tests were subjected to histopathology confirmation with colposcopy guided cervical punch biopsy.
Screen positivity rate for cervical cancer screening by VIA ,HPV DNA and Conventional Cytology test was 36.1% (105) , 32.3% (94) and 16.4% (48) respectively. Using a Histopathology CIN 2+ threshold, the sensitivity of VIA, HPV DNA and Conventional cytology tests were 0.96 (95% CI: 0.78 - 1.00), 0.91 (95% CI: 0.71 - 0.99) ,0.64 (95% CI: 0.41 - 0.83) and specificities were 0.70 (95% CI: 0.64 - 0.76), 0.71 (95% CI: 0.65 - 0.76), 0.98 (95% CI: 0.95 - 0.99) respectively.
The prevalence of HPV infection and CIN are significantly higher in the HIV-positive women in India. VIA performed equivalently to currently approved but expensive HPV DNA tests and was highly sensitive compared to conventional cytology. HPV DNA and cytology are currently not feasible in low resource settings due to its logistics, financial and technical requirements. It is feasible to integrate low cost VIA as a point of care cervix cancer screening modality that facilitate “See and Treat” approaches, which would improve compliance to pre cancer treatment with the current HIV testing and counseling centers in the country
1.Bruni L, Barrionuevo-Rosas L, Albero G, Aldea M, Serrano B, Valencia S, et al. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human papillomavirus and related diseases in India. Summary report 2015-12-23. Available from: http://www.who.int/hpvcentre, accessed on January 21, 2016.
2. Annual Report 2013-14. New Delhi: Department of AIDS Control, National AIDS Control Organization, Ministry of Health and Family Welfare, Government of India; 2014.