{"id":13947,"date":"2010-10-01T10:08:21","date_gmt":"2010-10-01T10:08:21","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=13947"},"modified":"2012-07-26T23:41:22","modified_gmt":"2012-07-26T23:41:22","slug":"hpv-based-screen-and-treat-is-effective-for-cervical-cancer-prevention-in-hiv-positive-women","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/13947","title":{"rendered":"HPV-based screen-and-treat is effective for cervical cancer prevention in HIV-positive women"},"content":{"rendered":"<p><strong>Polly Clayden, HIV i-Base<br \/>\n<\/strong><\/p>\n<p>Louise Khun and colleagues report results from a trial of a simple cervical cancer prevention strategy using non-cytological screening methods &#8211; ie HPV DNA testing or visual inspection with acetic acid (VIA) &#8211; with immediate treatment where indicated for HIV-positive South African women, in a paper published ahead of print in AIDS.<\/p>\n<p>The study authors note that it has been hard to establish conventional cytology based screening programmes in resource-limited settings. Yet, it is well known that HIV-positive women have high rates of human papillomavirus (HPV) and are at increased risk for developing cervical cancer. Furthermore as HIV-positive women are living longer on HAART, it is likely that more of these women will develop cervical cancer unless effective prevention strategies are put in place.<\/p>\n<p>This was a randomised controlled trial of two screen-and-treat strategies of over 7000 non-pregnant women age 35-65 recruited from three clinics in Khayelitsha between January 2000 and December 2002.<\/p>\n<p>Women were randomised into one of three study arms:<\/p>\n<ul>\n<li>HPV and treat &#8211; women with positive HPV test had cryotherapy<\/li>\n<li>VIA and treat \u0096 women with positive VIA test had cryotherapy<\/li>\n<li>Control group \u0096 evaluation or treatment was delayed for 6 months<\/li>\n<\/ul>\n<p>All women were followed at 6 months after randomisation with colposcopy and biopsy.<\/p>\n<p>The trail collected data on HIV status at baseline, 6, 12, 24 and 36 months. The investigators reported 956 women had an HIV-positive test at one of these visits.<\/p>\n<p>This report showed findings from a comparison of the effects of screen and treat among women ever testing positive compared to women who remained negative throughout follow up.<\/p>\n<p>The investigators conducted intent to treat analyses stratified by HIV status. The primary endpoint was cervical intraepithelial neoplasia grade 2 (CIN2+) or higher.<\/p>\n<p>They found, out of the HIV-positive women, 148 in the HPV-and-treat group and 104 in the VIA-and-treat group had a positive test result and underwent cryotherapy. Among the HIV-negative women, 319 and 377 in the HPV and VIA groups respectively had a positive test. There were no significant differences between HIV-positive and HIV-negative women in rates of complications and side effects in those who had cryotherapy.<\/p>\n<p>Using HPV DNA testing for screen-and-treat was highly effective in reducing the risk of CIN2+ by 36 months, both for HIV-positive, RR 0.20 (95% CI 0.06-0.69) and HIV-negative women, RR 0.31 (95% CI 0.20-0.50). The investigators observed less benefit for VIA-and-treat. This strategy reached statistical significance in HIV-positive women RR 0.51 (95% CI 0.29-0.89) but did not do so in HIV-negative women RR 0.76 (95% CI 0.52-1.1).<\/p>\n<p>The investigators estimated, for every 100 women screened, HPV-and-treat programme could prevent 11.9 CIN2+ cases in HIV-positive women and 3.1 in HIV-negative women. VIA-and-treat programme could prevent 7.4 cases in HIV-positive women and 1.1 in HIV negative women.<\/p>\n<p>Among the controls, higher rates of CIN2+ were detected by 36 months in HIV-positive than HIV-negative women, 14.9% vs 4.6%, p=0.0006.<\/p>\n<p>The rates were reduced significantly in the HPV-and-treat group, 3.1% in HIV-positive women and 1.4% in HIV-negative women, p&lt;0.0001. These reductions were less in the VIA-and-treat group, to 7.6% in HIV-positive women, p=0.002 and 3.5% in HIV-negative women, p=0.08.<\/p>\n<p>The sensitivity in the control group of HPV DNA testing at enrollment to detect CIN2+ through 36 months, was 87% in HIV-negative women and 94.4% in HIV-positive women, compared to 47.8% and 63.9% respectively in the VIA group. The positive predictive value (PPV) for HPV testing was only slightly higher among HIV-positive women than HIV-negative women, 29.9% vs 22.7% HPV-positive at baseline had CIN2+ by 36 months. For VIA this was nearly three times higher in the HIV-positive than HIV-negative women. The investigators explained that this was due to 62.2% of HIV-positive women with positive VIA test also having had HPV DNA detected vs. 26.6% of HIV-negative women.<\/p>\n<p>When they compared cryotherapy failure rates between HIV-positive and HIV-negative women, in the HPV-and-treat group, there was a slightly lower rate of CIN2+ after cryotherapy in HIV-positive (2.8%) vs HIV-negative (7.1%) women, p=0.05. In the VIA-and-treat group failure rates were similar in HIV-positive (4.8%) and negative (2.8%) women, p=0.43.<\/p>\n<p>The investigators wrote: \u0093Our data provide proof-of-principle that HPV-based screen-and-treat is safe and effective in HIV-positive women. A single round of screening with an HPV test followed by cryotherapy of all screen-positive women reduced high-grade cervical cancer precursors (CIN2+) by 80%, and this reduction was sustained through 36 months.\u0094<\/p>\n<p>Ref: Kuhn L et al. Efficacy of human papillomavirus-based screen and treat for cervical cancer prevention among HIV-infected women. AIDS 2010, published ahead of print 11 August 2010.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Polly Clayden, HIV i-Base Louise Khun and colleagues report results from a trial of a simple cervical cancer prevention strategy using non-cytological screening methods &#8211; ie HPV DNA testing or visual inspection with acetic acid (VIA) &#8211; with immediate treatment &hellip;<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[44,18],"tags":[],"class_list":["post-13947","post","type-post","status-publish","format-standard","hentry","category-womens-health","category-cancer-and-hiv"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/13947","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=13947"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/13947\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=13947"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=13947"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=13947"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}