Ahmadou Dem

The Impact of HIV Status and Type on the Clearance of Human Papillomavirus Infection among Senegalese Women

BACKGROUND Persistent infection with human papillomavirus (HPV) is associated with the development and progression of HPV-related disease, including cervical intraepithelial neoplasia (CIN) and invasive cervical cancer. METHODS We examined the impact of human immunodeficiency virus (HIV) status and type on the clearance of HPV infection among 614 Senegalese women enrolled in a longitudinal study of HPV and CIN. Women were examined every 4 months for HPV DNA. Clearance was defined as 2 consecutive negative HPV DNA test results. RESULTS Cox proportional hazard regression with time-dependent covariates indicated that HIV-positive women were less likely to clear HPV infection (adjusted hazard ratio [HR], 0.31 [95% confidence interval {CI}, 0.21-0.45]) than HIV-negative women. Among HIV-positive women, those with CD4 cell counts <200 or from 200 to 500 cells/microL showed a 71% (adjusted HR, 0.29 [95% CI, 0.11-0.76]) and 32% (adjusted HR, 0.68 [95% CI, 0.31-1.48]) reduction in the likelihood of HPV clearance, respectively, compared with those with CD4 cell counts >500 cells/microL. HIV-2 infection was associated with an increased likelihood of HPV clearance (adjusted HR, 2.46 [95% CI, 1.17-5.16]), compared with that for HIV-1 infection. CONCLUSIONS HIV infection reduces the likelihood of HPV clearance. Among HIV-positive women, immunosuppression, as measured by CD4 cell count, reduces the likelihood of HPV clearance, and HIV type appears to be associated with HPV clearance.

HIV infection as a risk factor for cervical cancer and cervical intraepithelial neoplasia in Senegal.

Cervical cancer is the second leading cause of cancer mortality in women worldwide, and the leading cause in Africa. There is uncertainty in the role of HIV infection as a risk factor for invasive and preinvasive cervical lesions, particularly in African populations. In a case-control study in Dakar, Senegal, we studied 150 women with invasive cervical cancer (ICC), 92 with cervical intraepithelial neoplasia (CIN) 2 or 3, 70 with CIN 1, and 515 control women. We used logistic regression analysis to estimate associations between HIV-1 and HIV-2 infection and the risk of cervical neoplasia. We found large increases in the risk of ICC and CIN 2-3, but not of CIN 1, associated with the presence of either HIV-1 or HIV-2 infection (odds ratios of 6.5 and 10.4 for ICC and CIN 2-3). Our analysis thus shows increases in the risk of both advanced and early cervical pathology associated with HIV infection in an African population. (Cancer Epidemiol Biomarkers Prev 2009;18(9):2442–6)

Influence of HIV-1 and/or HIV-2 infection and CD4 count on cervical HPV DNA detection in women from Senegal, West Africa

BACKGROUND HIV infection is associated with greater risk of precancerous lesions and cervical cancer in women. However, several factors remain unclarified regarding the association between HIV infection and HPV detection, especially among those with HIV type 2 versus type 1 infection and severely immunocompromised persons. OBJECTIVES To evaluate HPV overall and type-specific detection among HIV-infected and uninfected women in Senegal. STUDY DESIGN Detection of HPV DNA for 38 genotypes in cervical swabs using PCR-based methods was evaluated in HIV-positive (n=467) and HIV-negative (n=2139) women participating in studies in Senegal. Among HIV-1 and/or HIV-2 positive women, CD4 counts were assessed. Adjusted multivariable prevalence ratios (PR) were calculated. RESULTS The prevalence of any HPV DNA and multiple HPV types was greater among HIV-infected individuals (78.2% and 62.3%, respectively) compared with HIV-negative women (27.1% and 11.6%). This trend was also seen for HPV types 16 and 18 (13.1% and 10.9%) compared to HIV-negative women (2.2% and 1.7%). HIV-infected women with CD4 cell counts less than 200 cells/μl had a higher likelihood of any HPV detection (PRa 1.30; 95% CI 1.07-1.59), multiple HPV types (PRa 1.52; 95% CI 1.14-2.01), and HPV-16 (PRa 9.00; 95% CI 1.66-48.67), but not HPV-18 (PRa 1.20, 95% CI 0.45-3.24) compared to those with CD4 counts 500 cells/μl or above. CONCLUSION HIV-infected women, especially those most severely immunocompromised, are more likely to harbor HPV. Measures to prevent initial HPV infection and subsequent development of cervical cancer through focused screening efforts should be implemented in these high risk populations.

Human papillomavirus type 16 viral load in relation to HIV infection, cervical neoplasia and cancer in Senegal.

BACKGROUND The importance of human papillomavirus (HPV) viral load in the pathogenesis of cervical cancer among HIV-infected and HIV-uninfected women has not yet been established. METHODS In this cross-sectional study, HPV-16 viral loads were measured using previously-collected and frozen cervical swab samples from 498 HPV-16 positive Senegalese women (368 HIV-seronegative, 126 HIV-1 and/or HIV-2 seropositive). The real-time polymerase chain reaction assay was used to quantify HPV-16 E7 copy number normalized by human cellular DNA (β-actin), and viral loads were log10 transformed. Associations between HPV-16 viral load, degree of cervical abnormality, and HIV status were assessed using multinomial and linear regression methods. RESULTS Compared to women with normal cytology, the likelihood of CIN1 (ORa: 1.21, 95% CI 0.93-1.57), CIN2-3 (ORa: 2.38, 95% CI 1.72-3.29) and cancer (ORa: 2.12, 95% CI 1.52-2.96) was found to increase for each 1-unit log10 increase in HPV-16 viral load. Compared to HIV-negative women, HIV-positive women had higher average HPV-16 viral load values (βa: 0.39, 95% CI 0.03-0.75), even after accounting for degree of cervical abnormality. CONCLUSION In our study of women including those with cancer, HPV-16 viral load was associated with a higher likelihood of cervical abnormalities. However, substantial overlaps across categories of disease severity existed. Higher viral load among HIV-infected individuals may indicate that HIV infection influences HPV viral replication factors.

Biological evolution of tryptophan and phenylalanine in the occurrence of breast cancer in Senegalese women

The reports provided by OMS in 2011 revealed that cancer is a major cause of death worldwide, causing 7.6 million deaths in 2008. Breast cancer represents in the world, the most common malignancy of women, and it seems that the low penetrance genes, frequently mutated in the general population would play an important role in the development of this cancer. The purpose of this study is to evaluate the involvement of the protein diversity of cytochrome B (mitochondrial gene) in the occurrence of breast cancer in Senegalese women. We analyzed by PCR-sequencing cytochrome B variability in thirty Senegalese patients suffering from breast cancer. The nucleotide sequences obtained were transformed into amino acid sequences with BioEdit software version 7.0.8. Changes of one or more tryptophan to other amino acids, ranging normal tissue to cancerous tissue, are noted in some individuals with a penetrance of 72.41%. Our results also show a significant increase (79.3%) in the rate of phenylalanine in cancerous tissues with very different proportions between individuals. Any increase in the rate of tryptophan and phenylalanine in cancerous tissues could be correlated with an increased risk of developing breast cancer.

An exceptional case of bilateral gestational gigantomastia with multiple breast lumps

Bilateral gigantomastia is a rare condition, often associated with pregnancy that is characterized by a diffuse enlargement of both breasts. Here we present a case of a late 20s woman in her seven months pregnancy with a bilateral gestational gigantomastia associated with multiple breast lumps. Histological analysis revealed a fibroadenoma. Her prolactin level after caesarean delivery was found particularly high. A significant decrease in breast size was achieved with bromocriptine treatment in conjunction with a bilateral lumpectomy. This case report highlights the diversity of gigantomastia and emphasizes the importance of a tailored, multidisciplinary approach to the diagnosis and treatment of this condition.

Malignant chondroid syringoma in a West African cancer institute: A case report.

Highlights • Localization of the lesion.• Lesion masquerading as lymph node involvement.• Non effectivity of chemotherapy and radiotherapy.• Poor prognosis.

Étude du codon 72 du gène p53 dans la prédisposition au cancer du col de l’utérus au Sénégal

Beside human papilloma virus infection, several genetic factors have been involved in susceptibility to cervical cancer. The arginine allele at codon 72 in p53 tumor suppressor gene has been reported to be a risk-factor in different ethnic groups. Our aim was to study this polymorphism as a risk-factor in Senegal. We conducted a case-control association study by recruiting 30 patients with cervical cancer clinically followed up in the Curie Institute in Dakar, and 93 healthy female controls without diagnosed cervical cancer. For each individual, DNA was extracted from whole blood. The codon 72 polymorphism was genotyped by PCR-RFLP. We did not find any association between the arginine allele and susceptibility to cervical cancer in our population (P = 0.354). Moreover, any correlation between the arginine allele and histological lesions was observed. Even if we did not find any correlation between the arginine allele and susceptibility to cervical cancer, p53 as a tumor suppressor gene remains a good genetic marker in tumours biology.

Female genital mutilation and non-invasive cervical abnormalities and invasive cervical cancer in Senegal, West Africa: A retrospective study: Female genital mutilation and invasive cervical cancer in Senegal, West Africa

Female genital mutilation or cutting (FGM/C) is a traditional practice that affects a significant portion of women in sub‐Saharan Africa, Egypt, areas of the Middle East and some countries in Asia. While clinical and epidemiological studies have established a close association between inflammation and carcinogenesis, particularly in epithelial cancers, the relationship between FGM/C and cervical cancer is not well known.

Primary Sarcoma of the Great Omentum: A Case Report at the Joliot Curie Cancer Institute

Sarcomas of the omentum are rare. In this article, we report the case of a sarcoma of the omentum which was diagnosed and treated at the Joliot Curie Cancer Institute of Dakar. The patient was a 52-year-old woman with an abdominal mass that was mistaken for an ovarian tumor on clinical examination and on imaging. Surgical exploration helped find a sarcoma of the great omentum and treat the disease. Adjuvant treatments depend on the prognostic factors that need to be defined.