Department of Obstetrics and Gynecology and Office of Research and Graduate Studies, University of Botswana, Corner of Notwane and Mabuto Road, Gaborone, Botswana.
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA.
BMC Womens Health. 2022 Apr 2;22(1):100. doi: 10.1186/s12905-022-01680-7.
Women living with human immunodeficiency virus (HIV) tend to develop cervical cancer at a younger age than women without HIV. The World Health Organization's (WHO) 2021 guidelines for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention include a conditional recommendation for initiating screening at age 25 for women living with HIV (WLWH). This recommendation is based on low-certainty evidence, and WHO calls for additional data. We describe the association of age and HIV status with visual inspection with acetic acid (VIA) positivity and cervical intraepithelial neoplasia grade two or higher (CIN2+) in Botswana.
This was a retrospective cross-sectional study of 5714 participants aged 25 to 49 years who underwent VIA screening in a clinic mainly serving WLWH. VIA-positive women received cryotherapy if eligible or were referred for colposcopy and excisional treatment. Known cervical cancer risk factors, screening outcome, and histological results were extracted from the program database. We compared the proportions and association of VIA positivity and CIN2+ by age and HIV status.
The median age was 35 years [IQR 31-39], and 18% of the women were aged 25-29. Ninety percent were WLWH; median CD4 count was 250 cells/µL [IQR 150-428], and 34.2% were on anti-retroviral treatment (ART). VIA-positivity was associated with younger age (OR 1.48, CI 1.28, 1.72 for 25-29 years vs. 30-49 years), and HIV-positivity (OR 1.85, CI 1.51, 2.28). CIN2+ was only associated with HIV-positivity (OR 6.12, CI 3.39, 11.10), and proportions of CIN2+ were similar for both age groups in WLWH (69.1% vs. 68.3%).
Younger WLWH in Botswana had a significant burden of CIN2+. This finding further supports lowering the screening age for WLWH from 30 to 25.
与未感染 HIV 的女性相比，感染 HIV 的女性更容易在年轻时患上宫颈癌。世界卫生组织（WHO）2021 年关于宫颈癌前病变筛查和治疗的指南包括一项有条件的建议，即对感染 HIV 的女性（WHW）在 25 岁时开始筛查。这一建议是基于低确定性证据，世卫组织呼吁提供更多数据。我们描述了博茨瓦纳的 5714 名年龄在 25 至 49 岁之间的参与者，他们在一家主要为 WHW 服务的诊所接受了醋酸视觉检查（VIA）筛查。VIA 阳性的女性如果符合条件，则接受冷冻疗法，如果不符合条件，则转诊行阴道镜检查和切除治疗。从项目数据库中提取了已知的宫颈癌风险因素、筛查结果和组织学结果。我们比较了 VIA 阳性率和 CIN2+的比例和关联，按年龄和 HIV 状况进行比较。
中位年龄为 35 岁[IQR 31-39]，18%的女性年龄在 25-29 岁之间。90%的女性为 WHW；中位 CD4 计数为 250 个细胞/µL[IQR 150-428]，34.2%的人接受了抗逆转录病毒治疗（ART）。VIA 阳性与年龄较小（25-29 岁 vs. 30-49 岁的比值比 1.48，95%置信区间 1.28，1.72）和 HIV 阳性（比值比 1.85，95%置信区间 1.51，2.28）相关。CIN2+仅与 HIV 阳性相关（比值比 6.12，95%置信区间 3.39，11.10），且在 WHW 中，两个年龄组的 CIN2+比例相似（69.1% vs. 68.3%）。
博茨瓦纳的年轻 WHW 有很大的 CIN2+负担。这一发现进一步支持将 WHW 的筛查年龄从 30 岁降低到 25 岁。
