Whereas systematic screening programs have reduced the incidence of cervical cancer in developed countries, the incidence remains high in developing countries. Among several barriers to uptake of ...cervical cancer screening, the roles of religious and cultural factors such as modesty have been poorly studied. Knowledge about these factors is important because of the potential to overcome them using strategies such as self-collection of cervico-vaginal samples. In this study we evaluate the influence of spirituality and modesty on the acceptance of self-sampling for cervical cancer screening. We enrolled 600 participants in Nigeria between August and October 2014 and collected information on spirituality and modesty using 2 scales. We used principal component analysis to extract scores for spirituality and modesty and logistic regression models to evaluate the association between spirituality, modesty and preference for self-sampling. All analyses were performed using STATA 12. Some 581 (97%) women had complete data for analysis. Most (69%) were married, 50% were Christian and 44% were from the south western part of Nigeria. Overall, 19% (110/581) of the women preferred self-sampling to being sampled by a health care provider. Adjusting for age and socioeconomic status, spirituality, religious affiliation and geographic location were significantly associated with preference for self-sampling, while modesty was not significantly associated. The multivariable OR (95% CI, P-value) for association with self-sampling were 0.88 (0.78 to 0.99, 0.03) for spirituality, 1.69 (1.09 to 2.64, 0.02) for religious affiliation and 0.96 (0.86 to 1.08, 0.51) for modesty. Our results show the importance of taking cultural and religious beliefs and practices into consideration in planning health interventions like cervical cancer screening. To succeed, public health interventions and the education to promote it must be related to the target population and its preferences.
The burden of cervical cancer remains huge globally, more so in sub-Saharan Africa. Effectiveness of screening, rates of recurrence following treatment and factors driving these in Africans have not ...been sufficiently studied. The purpose of this study therefore was to investigate factors associated with recurrence of cervical intraepithelial lesions following Thermo-coagulation in HIV-positive and HIV-negative Nigerian women using Visual Inspection with Acetic Acid (VIA) or Lugol's Iodine (VILI) for diagnosis. A retrospective cohort study was conducted, recruiting participants from the cervical cancer "see and treat" program of IHVN. Data from 6 sites collected over a 4-year period was used. Inclusion criteria were: age >=18 years, baseline HIV status known, VIA or VILI positive and thermo-coagulation done. Logistic regression was performed to examine the proportion of women who returned for their scheduled follow-up, those with recurrence and factors associated with recurrence. Student's t test was used to compare continuous variables between HIV-positive and HIV-negative women while Fisher's exact test was performed for categorical variables. Out of 177 women included in study, 67.8% (120/177) were HIV-positive and 32.2% (57/177) were HIV-negative. Recurrence occurred in 16.4% (29/177) of participants; this was 18.3% (22/120) in HIV-positive women compared to 12.3% (7/57) in HIV-negative women but this difference was not statistically significant (P-value 0.31). Women aged >=30 years were much less likely to develop recurrence, adjusted OR = 0.34 (95% CI: 0.13 to 0.92). Among HIV-positive women, CD4 count <200 cells per cubic millimeter was associated with recurrence, adjusted OR = 5.47 (95% CI: 1.24 to 24.18). Recurrence of VIA or VILI positive lesions after Thermo-coagulation occurs in a significant proportion of women. HIV-positive women with low CD4 counts are at increased risk of recurrent lesions and may be related to immunosuppression.
The Human Papilloma Virus (HPV) is a necessary cause of cervical cancer and is associated with other cancers including vulval, vaginal, anal, penile and oropharyngeal cancers. In this study, we ...evaluate the burden of HPV associated cancers using data from population based cancer registries (PBCR) in Nigeria. We obtained data on cancers that are considered to be associated with HPV based on the IARC monograph 100b including cancers of the Cervix (C.53), Vulva (C.51), Vagina (C.52), Anus (C.21), Penis (C.60) and Oropharynx (C.01, C.09, C.10) from PBCR in Abuja (Central Nigeria), Enugu (Eastern Nigeria) and Calabar (South Eastern Nigeria). Previous literature using prevalence data and relative risks suggest that the Population Attributable Fractions (PAFs) for HPV associated cancers in developing countries were Cervical (100%) Vulval and Vaginal (40%), Anal (90%), Oropharynx (12%) in women and, Penile (40%) Anal (90%) Oropharynx (12%) in men. Among women, the 3 PBCR reported a total of 2,986 cases of cancer between 2012 and 2014 with 493 HPV associated cancers contributing 16.5% of the total cancers. Of the 493 HPV associated cancers, 430 were cervical cancers, 27 vulva cancers, 20 anal cancers, 8 vaginal cancers and 8 oropharyngeal cancers. Of these 463 (94%) were attributable to HPV infection. The PBCR reported 1875 cancers in men between 2012 and 2014. Of these, 40 were HPV associated cancers including 22 anal cancers, 16 oropharyngeal cancers and 2 penile cancers constituting (2%) of all cancers in men. Some 23 (57.5%) of the 40 HPV associated cancers were attributable to HPV infection. Cervical and vulva cancers were the most common HPV associated cancers among Nigerian women and anal cancers was the commonest HPV associated cancer in Nigerian men. Our findings suggest that approximately 57.5% of all HPV associated cancers in men and over 90% of all HPV associated cancers in women can be prevented if HPV infection is eliminated.
HIV-associated high-risk HPV infection in Nigerian women Akarolo-Anthony, Sally Nneoma; Ogbonna, Celestine C.; Famooto, Oluranti Ayotunde ...
Journal of clinical oncology,
05/2013, Letnik:
31, Številka:
15_suppl
Journal Article
Recenzirano
Abstract only
1576
Background: The incidence of cervical cancer has remained stable in HIV+ women but the prevalence and multiplicity of high risk HPV (hrHPV) infection, a necessary cause of cervical ...cancer, appears different comparing HIV+ to HIV- women. Because this has not been well studied in Africa, we conducted this study to identify single and multiple hrHPV infection among HIV+ and HIV- women in Nigeria. Methods: We enrolled HIV+ and HIV- women presenting at our cervical cancer screening program in Abuja, Nigeria between April 2012 and August 2012. Using a nurse administered questionnaire, we collected information on demographic characteristics, risk factors of HPV infection and cervical exfoliated cells samples from all participants. We used Roche Linear Array HPV Genotyping Test to characterize the prevalent HPV according to manufacturer’s instruction and logistic regression models to estimate the association between HIV infection and the risk of high-risk HPV infection. Results: There were 278 participants, 40% (111) of whom were HIV negative, 54% (151) HIV positive and 6% (16) with HIV status unknown. Of these, 108 HIV+ women cases and 149 HIV- women controls were available for analysis. The mean ages (±SD) were 37.6 (±7.7) for HIV+ and 36.6 (±7.9) years for HIV- women (p-value = 0.34). Cases and controls had similar socio-demographic characteristics. Among HIV+ women, HPV35 (8.7%) and HPV56 (7.4%) were the most prevalent hrHPV, while HPV52 and HPV68 (2.8%, each) were the most prevalent among HIV- women. The age adjusted RR for prevalent hrHPV was 4.18 (95% CI 2.05 – 8.49, p-value <0.0001), comparing HIV+ to HIV- women. The multivariate RR for any HPV and multiple hrHPV was 3.75 (95% CI 2.08 – 6.73, p-value 0.01) and 6.6 (95% CI 1.49 – 29.64, p-value 0.01) respectively, comparing HIV+ to HIV- women, adjusted for age, and educational level. Conclusions: HIV infection was associated with increased risk of any HPV, hrHPV and multiple HPV infections. Oncogenic HPV types 35, 52, 56 and 68 may be more important risk factors for cervical pre-cancer and cancer among women in Africa. Polyvalent hrHPV vaccines meant for African populations should protect against HPV types other than 16 and 18.
Abstract
The microbiota plays an important role in prevention of colonization of the vagina by pathogenic organisms such as HIV, Herpes simplex virus and N. gonorrhea. Given the role of persistent ...high risk HPV (hrHPV) infection of the cervix as a necessary but not sufficient cause of cervical, we hypothesized that in addition to other risk factors, specific community types of vaginal microbiota may be cofactors in the etiology of cervical cancer and pre-cancer (CIN2+).
We enrolled HIV+ and HIV- women who presented to our cervical cancer screening program at the National Hospital, Abuja and the University of Abuja Teaching Hospital, Abuja, Nigeria between April and August 2012 into this study. Using a nurse administered questionnaire, we collected information on demographics and risk factors of cervical cancer. Without cleaning the introitus, we collected mid-vaginal samples and cervical exfoliated cells from all participants.
We characterized the vaginal microbiota from the mid-vaginal sample by using barcoded universal primers 515F and 806R for the amplification of the V3 - V5 hypervariable regions of 16s rRNA gene and sequenced on an Illumina MiSeq Instrument. The processed gene sequences were classified using the RDP Naïve Bayesian Classifier and the vaginal microbiota were clustered into community state types (CST) according to community composition. We used Roche Linear Array HPV Genotyping Test® to characterize the prevalent HPV according to manufacturer's instruction. We analyzed association between community class types of vaginal microbiota and hrHPV infection using Fisher's exact tests.
We enrolled 278 women, 40% (111) of whom were HIV negative, 54% (151) HIV positive and 6% (16) with HIV status unknown. The prevalence of hrHPV types among the HIV- women was 10.6%, and 35.6% among the HIV+ women. hrHPV infection was commoner among HIV positive compared to HIV negative participants (OR 4.67, 95%CI 2.32 - 9.88, p<0.0001). The commonest clusters of vaginal microbiota CSTs that we identified in our sample were - Lactobacillus iners rich CST III and CST IV which lacked significant numbers of Lactobacillus. Amongst the HIV negative enrollees, participants with CST III were more likely to test positive for prevalent hrHPV than participants with CST IV (OR 3.6, 95% CI: 0.88 - 16.96, p = 0.05). Amongst the HIV positive participants, the presence of CST III was commoner among women with prevalent hrHPV but this was not statistically significant (OR 1.14, 95% CI 0.55 - 2.40, p=0.73)
Our results suggest that L.iners rich microbiota may be associated with increased risk of prevalent hrHPV infection in Nigerian women. Further research is needed to confirm this preliminary result and to evaluate the relationship of vaginal microbiota with persistent hrHPV infection.
This work was supported by the UM-Capacity Development for Research in AIDS Associated Malignancy Grant (NIH/NCI 1D43CA153792-01)
Citation Format: Eileen O. Dareng, Ayo O. Famooto, Celestine C. Ogbonna, Sally Akarolo-Anthony, Maryam Al-Mujtaba, George Odonye, Olayinka B. Olaniyan, Richard Offiong, Ishak Lawal, Pawel Gajer, Doug Fadrosh, Honqui Yang, Jacques Ravel, Clement Adebamowo. Increased risk of prevalent high risk human papillomavirus infection in Lactobacillus iners rich microbiota in Nigerian women. abstract. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2588. doi:10.1158/1538-7445.AM2013-2588
High risk HPV (hrHPV) infection is a necessary cause of cervical cancer but the host genetic determinants of infection are poorly understood. We enrolled 267 women who presented to our cervical ...cancer screening program in Abuja, Nigeria between April 2012 and August 2012. We collected information on demographic characteristics, risk factors of cervical cancer and obtained samples of blood and cervical exfoliated cells from all participants. We used Roche Linear Array HPV Genotyping Test registered to characterize the prevalent HPV according to manufacturer's instruction; Sequenom Mass Array to test 21 SNPs in genes/regions previously associated with hrHPV and regression models to examine independent factors associated with HPV infection. We considered a p<0.05 as significant because this is a replication study. There were 65 women with and 202 women without hrHPV infection. Under the allelic model, we found significant association between two SNPs, rs2305809 on RPS19 and rs2342700 on TYMS, and prevalent hrHPV infection. Multivariate analysis of hrHPV risk adjusted for age, body mass index, smoking, age of menarche, age at sexual debut, lifetime total number of sexual partners and the total number of pregnancies as covariates, yielded a p-value of 0.071 and 0.010 for rs2305809 and rs2342700, respectively. Our findings in this unique population suggest that a number of genetic risk variants for hrHPV are shared with other population groups. Definitive studies with larger sample sizes and using genome wide approaches are needed to understand the genetic architecture of hrHPV risk in multiple populations.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background: Persistent infection with high risk HPV is a necessary but insufficient cause of cervical cancer. Behavioural, viral and host factors modulate the risk of HPV persistence. In this thesis, ...I explore the role of the vaginal microbiota, a host factor and the presence of multiple HPV infections, a viral factor in HPV persistence. Considering the limited data on the epidemiology of HPV related diseases in low and middle-countries (LMIC), and the limited success of cervical cancer screening strategies in many LMIC, I provide data on the distribution of HPV related diseases in Nigeria and evaluate the acceptability of innovative strategies to increase cervical cancer screening uptake. Methods/Results: To achieve my aims, I implemented a longitudinal cohort study of 1,020 women in Nigeria. I begin my results chapters with two methodological papers. Attrition is an important consideration for every longitudinal cohort, particularly in LMIC, therefore, I present my findings on attrition, determinants of attrition and practical strategies to ensure low attrition in studies conducted in LMIC. Considering that sexual behaviour is an important potential confounder in all HPV studies, and the reliability of self-reported history is often questioned, I present findings on the test-retest reliability of self-reported sexual behaviour history collected in my study. Having found that attrition levels were low and that self-reported sexual behaviour history was generally reliable within my cohort, I present my findings on the association between the vaginal microbiota and persistent hrHPV; and the role of multiple HPV infections in viral persistence. I found that the vaginal microbiota was associated with persistent hrHPV in HIV negative women, but not in HIV positive women; and that multiple HPV infections did not increase the risk of viral persistence when compared to single HPV infections. Next, I present my findings on the prevalence and incidence of anogenital warts in Nigeria, with additional reports on the prevalence of cervical cancer and other HPV associated cancers using data from two population based cancer registries. Finally, I present my findings on the acceptability of innovative strategies to improve cervical cancer screening uptake in Nigeria. I found that Nigerian women had a favorable attitude to the use of HPV DNA based screening as part of routine antenatal care, however attitudes towards the use of self-sampling techniques for HPV based cervical cancer screening varied by religious affiliations. Conclusion: In my thesis, I was able to systematically investigate the epidemiology of HPV infections in a LMIC. I considered the distribution of HPV related diseases, host and viral determinants of HPV persistence and investigated control strategies to reduce the burden of cervical cancer in a LMIC. My results provide useful data for surveillance, monitoring and evaluation of control programs on HPV and cervical cancer in Nigeria and may be useful to cervical cancer control programs in other LMIC.
Abstract 66
Sexual behaviour is an important risk factor for HPV associated cancers, which include nearly all cervical cancers, most anal cancers, and many oropharyngeal, vaginal, vulvar and penile ...cancers. However, in studies assessing risk of sexual behaviour and disease in low and middle income countries, there are often questions about the validity of self-reported sexual behaviour. In this study, we evaluate the reliability of self-reported sexual history among participants in a cervical cancer and HPV study in Nigeria.
We studied 720 participants in a prospective cohort. We collected general sexuality and specific sexual practices information at study entry and administered the same questions at follow up after a mean period of 8.6 months. To assess reliability, we used the root mean squared approach to calculate within-person coefficient of variation(CVw) and calculated the intra-class correlation coefficient (ICC) using a two way, mixed effects model (continuous variables) and κ statistics (discrete variables).
Of the 720 participants, 48.1% were HIV+, 49.2% were HIV- and 2.8% were unaware of their status. Agreement was higher for HIV- women than HIV+ women. Agreement for ever engaged in oral sex was moderate for HIV- women (κ = 0.56, 95%CI = 0.49 – 0.70) and fair for HIV+ women (κ = 0.37, 95%CI = 0.24 – 0.54). Similarly, agreement for ever engaging in anal sex was good among HIV- women (κ = 0.61, 95%CI = 0.10 – 0.83) and poor among HIV+ women (κ = 0.19, 95%CI = 0.10 – 0.60). Overall, the within person variability for age at sexual debut for vaginal sex (CVw =10.7, 95%CI = 10.6 – 10.7) and oral sex (CVw= 11.5, 95%CI = 11.5 – 11.6) was low. In contrast, the variability was much higher for lifetime number of partners for vaginal sex (CVw =35.2, 95% CI = 35.1 – 35.3) and oral sex (CVw = 34.0, 95%CI = 34.0– 34.1).
We found report of sexual behaviour was more reliable among HIV- women than HIV+ women, and self-report of ever engaged in a sexual practice and age at initiation were more reliable than reports of frequency or number of partners.
AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST:
No COIs from the authors.
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