Cervical Cancer Screening in HIV-Positive Women in India: Why, When and How?
Background
Cervical cancer is an AIDS-defining illness, and HIV-positive women are at high risk. The present study aimed to determine the magnitude of the problem, compare the performance of screening tests and assess factors affecting participation.


Methods
HIV-positive women aged 30-59 years attend the anti-retroviral therapy (ART) clinics were screened by conventional Pap, HPV testing (Hybrid Capture 2) and visual inspection with acetic acid (VIA). A cohort of HIV-negative women from the community matched for age and parity were screened similarly. Screen-positive women underwent colposcopy and biopsy. Factors affecting participation were assessed.


Results
Pap, VIA and HPV were positive in 48 (23.8%), 65 (32.2%) and 76 (37.6%) subjects, respectively, among HIV-positive women, and in 12 (5.9%), 10 (4.9%) and 12 (5.9%) subjects, respectively, among HIV-negative women. CIN2 + was present in 12 (6.4%) HIV-positive women and in 1(0.5%) HIV-negative woman (p =  < 0.004). Sensitivity of HPV, Pap and VIA for detection of CIN2 + lesions was 91.7%, 75.0% and 75.0%, respectively; specificity was 68.4%, 83.9% and 72.5%, respectively. Lack of availability of screening facilities in the ART clinic and long waiting times were a strong deterrent to participation among HIV-positive women.


Conclusions
There was higher prevalence of HPV infection and CIN2 + lesions in HIV-positive women. VIA showed equivalent sensitivity to Pap and could be a good substitute in low resource settings. Setting up cervical screening services in ART clinics and sensitising physicians can improve outcomes among these women.
['Boddu|Amulya|A|', 'Bhatla|Neerja|N|0000-0002-3894-2795', 'Vashist|Shachi|S|', 'Mathur|Sandeep|S|', 'Mahey|Reeta|R|', 'Natarajan|Jayashree|J|', 'Malik|Ria|R|', 'Vanamail|Perumal|P|', 'Rai|Shweta|S|', 'Kumari|Aruna|A|', 'Dar|Lalit|L|', 'Wig|Naveet|N|']
Cervical cancer Screening Pap VIA Colposcopy Barriers CIN HIV