Cervical precancerous lesions in HIV-positive women in Cameroon: Prevalence, predictors and potential impact of screening

Cervical cancer is the most common cancer in women in low-income countries. Although cervical cancer incidence and mortality is higher in HIV-positive women, resource limitations restrict the implementation of systematic screening programs in these women. The purpose of this dissertation was to explore the potential for targeted screening by assessing the prevalence and clinical predictors of cervical squamous intra-epithelial lesions (SIL) in HIV-positive women in Cameroon. Furthermore, we sought to explore the potential impact of antiretroviral therapy and screening on mortality from cervical cancer.;We initially conducted a cross-sectional study of HIV-positive women in Cameroon. A total of 282 women, aged 19 to 68 years with a median CD4 cell count of 179 cells/microliter, were enrolled. SIL were detected in 43.5% of the 276 women with satisfactory samples: including high-grade SIL (HSIL) in 3.3%. None of the clinical factors assessed significantly predicted the presence of any lesion. Among patients with CD4 counts less than 200 cells/microliter, the prevalence of SIL was higher in patients aged 26--59 years compared to younger women, while there was essentially no difference amongst women with CD4 counts greater than 200 cells/microliter.;Using a Markov state-transition model of a cohort of HIV-positive women in Cameroon, we examined the potential impact of scenarios including: no HAART and no screening (NHNS); HAART and no screening (HNS); and HAART and screening once at age 35 (HS35). Compared to NHNS, lifetime cumulative cervical cancer mortality doubled with HNS. It will require 202 women being screened at age 35 to prevent one cervical cancer death amongst women on HAART.;The high prevalence of SIL in women initiating antiretroviral therapy in Cameroon underscores the need for screening in this population. With neither age nor any other clinical factor being a good predictor of SIL, alternative affordable screening options need to be explored. Furthermore, the long-term evolution of SIL needs to be assessed in prospective studies of these women. Screening has the potential of reducing cervical cancer mortality in HIV-positive women in Africa. The cost of achieving such an effect needs to be assessed.