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Published in: BMC Public Health 1/2008

Open Access 01-12-2008 | Research article

Association between invasive cancer of the cervix and HIV-1 infection in Tanzania: the need for dual screening

Authors: Crispin Kahesa, Julius Mwaiselage, Henry R Wabinga, Twalib Ngoma, Joan N Kalyango, Charles AS Karamagi

Published in: BMC Public Health | Issue 1/2008

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Abstract

Background

Cancer of the cervix is the second commonest malignancy in females worldwide and is the leading malignancy among women in Tanzania. Cancer of the cervix has been strongly associated with Human Papilloma Virus (HPV) which is a sexually transmitted disease. However, the role of HIV-1 in the aetiology of cancer of the cervix is less clear. Studies suggest that HPV and HIV-1 infection are synergistic and therefore their dual occurrence may fuel increased incidence of cancer of the cervix and AIDS. We therefore conducted a study to determine the association between cancer of the cervix and HIV-1.

Methods

The study was carried out in Ocean Road Cancer Institute, Dar-es-salaam, Tanzania between January and March 2007. A hospital-based case control design was used to study 138 cases and 138 controls. The cases were consenting women 18 years and above with histologically confirmed squamous cell carcinoma of the cervix, while the controls were consenting non-cancer adult women attendants or visitors. The participants were counselled and tested for HIV-1 and interviewed to assess risk factors for cancer of the cervix and HIV-1. Estimation of risk was done by computing odds ratios and confidence intervals. Confounding and interaction between the factors were assessed using logistic regression.

Results

HIV-1 prevalence was much higher among the cases (21.0%) than among the controls (11.6%). In logistic regression, HIV-1 was associated with cancer of the cervix (OR = 2.9, 95% CI = 1.4–5.9). Among the cases the mean age was lower for HIV-1 infected (44.3 years) than HIV-1 uninfected women (54 years, p = 0.0001).

Conclusion

HIV-1 infection is associated with invasive cancer of the cervix. Resource-constrained countries with a high burden of HIV-1 and cervical cancer should adopt a high-risk approach that targets HIV-1 positive women for screening of cervical cancer initially by utilizing HIV/AIDS resources.
Literature
1.
Parkin DM, Pisani P, Ferlay J: Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer. 1999, 80: 827-841. 10.1002/(SICI)1097-0215(19990315)80:6<827::AID-IJC6>3.0.CO;2-P.CrossRefPubMed
2.
Wabinga HR, Parkin DM, Wabwire-Mangen F, Nambooze S: Trends in cancer incidence in Kyadondo County, Uganda, 1960–1997. Br J Cancer. 2000, 82 (9): 1585-1592. 10.1054/bjoc.1999.1071.CrossRefPubMedPubMedCentral
3.
Gustafsson L, Pontén J, Zack M, Adami HO: International incidence rates of invasive cervical cancer after introduction of cytological screening. Cancer Causes Control. 1997, 8 (5): 755-763. 10.1023/A:1018435522475.CrossRefPubMed
4.
Hakama M, Chamberlain J, Day NE, Miller AB, Prorok PC: Evaluation of screening programmes for gynaecological cancer. Br J Cancer. 1985, 52 (4): 669-673.CrossRefPubMedPubMedCentral
5.
Murri R, Franceschi S, Ravizza M, Fiore S, Bini T, Mussini C, Fasolo M, Liuzzi G, Ippolito G, D'Arminio Monforte A: Access to gynecological services and Papanicolau tests in HIV-infected Italian women: a questionnaire survey. AIDS Care. 2006, 18 (4): 376-378. 10.1080/09540120500409267.CrossRefPubMed
6.
Sirovich BE, Welch HG: The frequency of Pap smear screening in the United States. J Gen Intern Med. 2004, 19 (3): 243-250. 10.1111/j.1525-1497.2004.21107.x.CrossRefPubMedPubMedCentral
7.
Chirenje ZM, Rusakaniko S, Kirumbi L, Ngwalle EW, Makuta-Tlebere P, Kaggwa S, Mpanju-Shumbusho W, Makoae L: Situation analysis for cervical cancer diagnosis and treatment in east, central and southern African countries. Bull World Health Organ. 2001, 79 (2): 127-132.PubMedPubMedCentral
8.
WHO: Control of cancer of the cervix uteri (Memorandum from a WHO meeting). Bull World Health Organ. 1986, 64: 607-618.
9.
Bayo S, Bosch FX, de Sanjose S, Munoz N, Combita AL, Coursaget P, Diaz M, Dolo A, Brule van den AJ, Meijer CJ: Risk factors of invasive cervical cancer in Mali. Int J Epidemiol. 2002, 31: 202-209. 10.1093/ije/31.1.202.CrossRefPubMed
10.
Brinton LA, Reeves WC, Brenes MM, Herrero R, de Britton RC, Gaitan E, Tenorio F, Garcia M, Rawls WE: Parity as a risk factor for cervical cancer. Am J Epidemiol. 1989, 130 (3): 486-496.PubMed
11.
Plummer M, Herrero R, Franceschi S, Meijer CJ, Snijders P, Bosch FX, de Sanjosé S, Muñoz N, IARC Multi-centre Cervical Cancer Study Group: Smoking and cervical cancer: pooled analysis of the IARC multi-centric case – control study. Cancer Causes Control. 2003, 14 (9): 805-814. 10.1023/B:CACO.0000003811.98261.3e.CrossRefPubMed
12.
13.
Walboomers JMM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, Snijders PJF, Peto J, Meijer CJLM, Munoz N: Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999, 189: 12-19. 10.1002/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F.CrossRefPubMed
14.
Clifford GM, Gallus S, Herrero R, Munoz N, Snijders PJF, Vaccarella S, Anh PTH, Ferreccio C, Hieu NT, Matos E, et al: Worldwide distribution of human papillomavirus types in cytologically normal women in the International Agency for Research on Cancer HPV prevalence surveys: a pooled analysis. Lancet. 2005, 366: 991-998. 10.1016/S0140-6736(05)67069-9.CrossRefPubMed
15.
Muñoz N, Bosch FX, de Sanjosé S, Herrero R, Castellsagué X, Shah KV, Snijders PJ, Meijer CJ, International Agency for Research on Cancer Multicenter Cervical Cancer Study Group: Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003, 348 (6): 518-527. 10.1056/NEJMoa021641.CrossRefPubMed
16.
Didelot-Rousseau MN, Nagot N, Costes-Martineau V, Vallès X, Ouedraogo A, Konate I, Weiss HA, Perre Van de P, Mayaud P, Segondy M, et al: Human papillomavirus genotype distribution and cervical squamous intraepithelial lesions among high-risk women with and without HIV-1 infection in Burkina Faso. Br J Cancer. 2006, 95 (3): 355-362. 10.1038/sj.bjc.6603252.CrossRefPubMedPubMedCentral
17.
La Ruche G, You B, Mensah-Ado I, Bergeron C, Montcho C, Ramon R, Toure-Coulibaly K, Welffens-Ekra C, Dabis F, Orth G: Human papillomavirus and human immunodeficiency virus infections: relation with cervical dysplasia -neoplasia in African women. Int J Cancer. 1998, 76: 480-486. 10.1002/(SICI)1097-0215(19980518)76:4<480::AID-IJC6>3.0.CO;2-N.CrossRefPubMed
18.
Ng'andwe C, Lowe JJ, Richards PJ, Hause L, Wood C, Angeletti PC: The distribution of sexually-transmitted Human Papillomaviruses in HIV positive and negative patients in Zambia, Africa. BMC Infect Dis. 2007, 7: 77-10.1186/1471-2334-7-77.CrossRefPubMedPubMedCentral
19.
Hawes SE, Critchlow CW, Sow PS, Touré P, N'Doye I, Diop A, Kuypers JM, Kasse AA, Kiviat NB: Incident high-grade squamous intraepithelial lesions in Senegalese women with and without human immunodeficiency virus type 1 (HIV-1) and HIV-2. J Natl Cancer Inst. 2006, 98 (2): 100-109.CrossRefPubMed
20.
Baay MF, Kjetland EF, Ndhlovu PD, Deschoolmeester V, Mduluza T, Gomo E, Friis H, Midzi N, Gwanzura L, Mason PR, et al: Human papillomavirus in a rural community in Zimbabwe:the impact of HIV-1 co-infection on HPV genotype distribution. J Med Virol. 2004, 73: 481-485. 10.1002/jmv.20115.CrossRefPubMed
21.
Strickler HD, Burk RD, Fazzari M, Anastos K, Minkoff H, Massad LS, Hall C, Bacon M, Levine AM, Watts DH, et al: Natural history and possible reactivation of human papillomavirus in human immunodeficiency virus-positive women. J Natl Cancer Inst. 2005, 97: 577-586.CrossRefPubMed
22.
Centers for Disease Control and Prevention: 1993 revised classification system for HIV-1 infection and expanded surveillance case definition for AIDS among adolescents and adults. JAMA. 1993, 269: 729-730. 10.1001/jama.269.6.729.CrossRef
23.
Selik RM, Rabkin CS: Cancer death rates associated with human immunodeficiency virus infection in the United States. J Natl Cancer Inst. 1998, 90 (17): 1300-1302. 10.1093/jnci/90.17.1300.CrossRefPubMed
24.
Serraino D, Dal Maso L, La Vecchia C, Franceschi S: Invasive cervical cancer as an AIDS-defining illness in Europe. AIDS. 2002, 16 (5): 781-786. 10.1097/00002030-200203290-00014.CrossRefPubMed
25.
Chirenje ZM: HIV and cancer of the cervix. Best Pract Res Clin Obstet Gynaecol. 2005, 19 (2): 269-276. 10.1016/j.bpobgyn.2004.10.002.CrossRefPubMed
26.
Hawes SE, Critchlow CW, Faye Niang MA, Diouf MB, Diop A, Toure' P, Kasse AA, Dembele B, Salif Sow P, Coll-Seck AM, et al: Increased risk of high-grade cervical squamous intraepithelial lesions and invasive cancer among African women with human immunodeficiency virus type 1 and 2 infections. J Infect Dis. 2003, 188: 555-563. 10.1086/376996.CrossRefPubMed
27.
Mbulaiteye SM, Katabira ET, Wabinga H, Parkin DM, Virgo P, Ochai R, Workneh M, Coutinho A, Engels EA: Spectrum of cancers among HIV-infected persons in Africa: the Uganda AIDS-Cancer Registry Match Study. Int J Cancer. 2006, 118 (4): 985-990. 10.1002/ijc.21443.CrossRefPubMed
28.
Moodley JR, Hoffman M, Carrara H, Allan BR, Cooper DD, Rosenberg L, Denny LE, Shapiro S, Williamson A: HIV and pre-neoplastic and neoplastic lesions of the cervix in South Africa: a case control study. BMC Cancer. 2006, 6 (135):
29.
Parkin DM, Wabinga H, Nambooze S, Wabwire-Mangen F: AIDS-related cancers in Africa: maturation of the epidemic in Uganda. AIDS. 1999, 13 (18): 2563-2570. 10.1097/00002030-199912240-00010.CrossRefPubMed
30.
Sekirime WK, Gray R: HIV infection among Uganda women with cervical cancer: a retrospective study. Gynecol Obstet Invest. 2007, 63 (4): 222-228. 10.1159/000098197.CrossRefPubMed
31.
Ter Meulen J, Eberhardt HC, Luande J, Mgaya HN, Chang-Claude J, Mtiro H, Mhina M, Kashaija P, Yu X, Meinhardt G, et al: Human papillomavirus (HPV) infection, HIV-1 infection and cervical cancer in Tanzania, East Africa. Int J Cancer. 1992, 51: 515-521. 10.1002/ijc.2910510403.CrossRefPubMed
32.
Newton R, Ziegler J, Beral V, Mbidde E, Carpenter L, Wabinga H, Mbulaiteye S, Appleby P, Reeves G, Jaffe H, et al: A case-control study of human immunodeficiency virus infection and cancer in adults and children residing in Kampala, Uganda. Int J Cancer. 2001, 92 (5): 622-627. 10.1002/1097-0215(20010601)92:5<622::AID-IJC1256>3.0.CO;2-K.CrossRefPubMed
33.
Sitas F, Pacella-Norman R, Carrara H, Patel M, Ruff P, Sur R, Jentsch U, Hale M, Rowji P, Saffer D, et al: The spectrum of HIV-1 related cancers in South Africa. Int J Cancer. 2000, 88 (3): 489-492. 10.1002/1097-0215(20001101)88:3<489::AID-IJC25>3.0.CO;2-Q.CrossRefPubMed
34.
Stein L, Urban MI, O'Connell D, Yu XQBV, Newton R, Ruff P, Donde B, Hale M, Patel M, Sitas F: The spectrum of human immunodeficiency virus-associated cancers in a South African black population: Results from a case-control study, 1995–2004. Int J Cancer. 2008, 122 (10): 2260-2265. 10.1002/ijc.23391.CrossRefPubMed
35.
36.
Moodley M, Mould S: Invasive cervical cancer and human immunodeficiency virus (HIV) infection in KwaZulu-Natal, South Africa. J Obstet Gynaecol. 2005, 25 (7): 706-710. 10.1080/01443610500294599.CrossRefPubMed
37.
Wabinga H, Ramanakumar AV, Banura C, Luwaga A, Nambooze S, Parkin DM: Survival of cervix cancer patients in Kampala, Uganda: 1995–1997. Br J Cancer. 2003, 89 (1): 65-69. 10.1038/sj.bjc.6601034.CrossRefPubMedPubMedCentral
38.
Stein L, Urban MI, O'Connell D, Yu XQ, Beral V, Newton R, Ruff P, Donde B, Hale M, Patel M, et al: The spectrum of human immunodeficiency virus-associated cancers in a South African black population: Results from a case-control study, 1995–2004. Int J Cancer. 2008, 122 (10): 2260-2265. 10.1002/ijc.23391.CrossRefPubMed
39.
Herrington CS: Do HPV-negative cervical carcinomas exist? – revisited. J Pathol. 1999, 189 (1): 1-3. 10.1002/(SICI)1096-9896(199909)189:1<1::AID-PATH432>3.0.CO;2-P.CrossRefPubMed
40.
Bosch FX, Lorincz A, Muñoz N, Meijer CJ, Shah KV: The causal relation between human papillomavirus and cervical cancer. J Clin Pathol. 2002, 55 (4): 244-265.CrossRefPubMedPubMedCentral
41.
42.
Newfield L, Bradlow HL, Sepkovic DW, Auborn K: Estrogen metabolism and the malignant potential of human papillomavirus immortalized keratinocytes. Proc Soc Exp Biol Med. 1998, 217 (3): 322-326.CrossRefPubMed
43.
Ngwalle EW, Mgaya HN, Mpanju-Shumbusho W, Chirenje ZM, Kirumbi L, Lebelle T, Kaggwa S: Situational analysis for diagnosis and treatment of cervical cancer in mainland Tanzania. East Afr Med J. 2001, 78 (2): 60-64.CrossRefPubMed
44.
Franceschi S, Jaffe H: Cervical cancer screening of women living with HIV infection: a must in the era of antiretroviral therapy. Clin Infect Dis. 2007, 45 (4): 510-513. 10.1086/520022.CrossRefPubMed
45.
Parham GP, Sahasrabuddhe VV, Mwanahamuntu MH, Shepherd BE, Hicks ML, Stringer EM, Vermund SH: Prevalence and predictors of squamous intraepithelial lesions of the cervix in HIV-infected women in Lusaka, Zambia. Gynecol Oncol. 2006, 103 (3): 1017-1022. 10.1016/j.ygyno.2006.06.015.CrossRefPubMedPubMedCentral
Metadata
Title
Association between invasive cancer of the cervix and HIV-1 infection in Tanzania: the need for dual screening
Authors
Crispin Kahesa
Julius Mwaiselage
Henry R Wabinga
Twalib Ngoma
Joan N Kalyango
Charles AS Karamagi
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2008
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-8-262

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