Recurrence of cervical intraepithelial lesions after thermo-coagulation in HIV-positive and HIV-negative Nigerian women

Emmanuel A. Oga, Jessica P. Brown, Clayton Brown, Eileen Dareng, Victor Adekanmbi, Michael Odutola, Olayinka Olaniyan, Richard Offiong, Kayode Obende, Ayodele Stephen Adewole, Achara Peter, Patrick Dakum, Clement Adebamowo

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Background: 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. Methods: 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 with recurrence and to examine factors associated with recurrence. Results: 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, 0.92). Among HIV-positive women, CD4 count < 200cells/mm3 was associated with recurrence, adjusted OR = 5.47 (95 % CI = 1.24, 24.18). Conclusion: 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.

Original languageEnglish (US)
Article number25
JournalBMC Women's Health
Volume16
Issue number1
DOIs
StatePublished - 2016
Externally publishedYes

Keywords

  • Ablation
  • Acetic acid
  • Cervical Intraepithelial Neoplasia (CIN)
  • Cervical Intraepithelial lesions
  • Cervical cancer
  • Cold coagulation
  • HIV
  • Lugol's Iodine
  • Recurrence
  • See-and-treat and Nigeria
  • Thermo-coagulation
  • Visual inspection

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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