Patrick H. Daru

High-risk human papilloma virus and cervical abnormalities in HIV-infected women with normal cervical cytology

BackgroundThe prevalence of High-Risk Human papilloma virus (HR-HPV), a necessary cause of invasive cervical cancer (ICC) is relatively high in HIV infected women. Gaps exist in our knowledge of the optimal approaches for managing women who have HR-HPV with normal cervical cytology (NCC) particularly in settings of HIV infection.MethodsBetween May 2012 and June 2013 we conducted a colposcopic assessment of HIV-infected women with prior (NCC) and known HR-HPV status to compare cervical abnormalities in women with and without HR-HPV. Colposcopic examinations were done at the Operation Stop Cervical Cancer (OSCC) unit of the Jos University Teaching Hospital (JUTH), Jos, Nigeria. Abnormal colposcopic finding (ACF) was defined as areas of aceto-white epithelium involving the squamo-coulumnar junction, areas of punctation, mosaic pattern or atypical vessels. We compared proportions of ACF as well as histologic grades of cervical intra-epithelial neoplasia (CIN) in women with or without HR-HPV. Statistical analysis was done on STATA.ResultsWe conducted colposcopic examinations in 78 out of 89 (86.5%) eligible women. The mean age of the cohort was 32.4 years (SD ±4.6) with a median 32 years (IQR 29–36). After a mean follow up time of 20.1 months from the initial cervical pap cytology and HR-HPV testing, we found 12 of 78 (15.4%) women with ACF. The odds for an ACF was statistically higher [OR = 4.0 (95% CI: 1.1-14.7)] in women with HR-HPV compared to those without. Of the twelve women with ACF, subsequent histologic examination of colposcopically directed cervical biopsies confirmed CIN 1 in 4 cases (33.3%), CIN 2 in 1 case (8.3%), CIN 3 in 2 cases (16.7%), carcinoma-in-situ (CIS) in 2 cases (16.7%), and normal cervix in 3 (25.0%). Overall, the proportion of women detected with any grade of CIN was 11.5% (9/78) and 6.4% (5/78) were CIN 2 or greater lesion (CIN2+).ConclusionHIV-infected women with NCC and HR-HPV had a four-fold higher likelihood for an ACF. The practice of early colposcopic examination of HIV-infected women with prior NCC and HR-HPV may increase early detection of higher grade CIN and CIS cancer stages in our setting.

Incidence and risk factors for pre-eclampsia in Jos Nigeria

Objective We sought to estimate the incidence and risk factors associated with development of pre-eclampsia (PET) in Jos, Nigeria. Methods An open cohort study of singleton pregnant women attending the antenatal clinic of Jos University Teaching Hospital (JUTH), Nigeria between November 2010 and August 2011. Eligible healthy women at ≤ 20 weeks gestation were enrolled and followed up until delivery or development of pre-eclampsia. Baseline demographic characteristics including weight, height and body mass index (BMI) were collected at enrollment. Incidence, risk factors and hazard ratios for developing PET were estimated with corresponding 95% confidence intervals and p-values. All statistical analyses were done with STATA version 11, college station, Texas, USA. Results A total of 2416 pregnant women were screened for eligibility out of which 323 were eligible for inclusion. The incidence of PET was 87.9 per 1,000 pregnancies (8.8%). The significant risk factors for PET were previous history of PET (RR=5.1, 95% CI: 2.2–12.1) and BMI at booking ≥ 25 kg/m2 (RR=3.9, 95% CI: 1.5–10.0). Conclusion The incidence of PET was relatively high in our cohort in Jos, Nigeria and a previous history of the disease and overweight or obese pregnant women have a significant hazard of developing the disease in the course of gestational follow up. Targeting women with these characteristics for early preventive intervention and close surveillance at the antenatal booking clinic may help in prevention of the disease and its complications.

Hysterosalpingographic evaluation of 998 consecutive infertile women in Jos, Nigeria.

risk and low-risk HPV, and 8 (6.8%) cases of low-risk HPV identified. The HPV genotype could not be identified in 16 (13.6%) women. Half of the high-risk genotypes identified were types 16 and 18, and the rest were of 9 different types (Table 1). In univariate analysis, age and crack cocaine use were significantly associated with HPV infection (Table 2), but did not remain so following multivariate analysis. With multivariate analysis, crack cocaine use remained independently associated with high-risk HPV genotypes (OR 15.6; 95% CI, 1.67–146.4, P=0.016). Few studies have been conducted on the prevalence of HPV among HIV-negative female drug addicts and the existing literature relates primarily to female addictswho areHIV positive. Dev et al. [2] reported a 26% prevalence rate of HPV in drug-addicted women [2], while the present study reported a relatively higher rate of 50%. Dev et al. [2] reported no cases of high-risk HPV at the beginning of the study, whereas in the present study 29.7% (35/118 women) had a high-risk type. In a study by Syrjanen et al. [3], the prevalence of high-risk HPV among addicted women was approximately 30%, which was higher than for their control group (21.9%). In the present study the prevalence of HIV was 6.8%, which is higher than the overall rate in Iran (b1%) but less than that reported by Dev et al. [2]; the prevalence of HIV was not reported by Syrjanen et al. [3]. Of note is the prevalence of crack cocaine use among our study participants. Crack cocaine is among the newer drug substances available and, therefore, this study is of particular importance for public health policy decision-makers. Although the most prevalent high-risk HPV types were types 16 and 18, other high-risk types such as 51 and 35 were seen in a high number of participants. Existing HPV vaccines cover only 4 types (18, 16, 11, 6); therefore, production of vaccines covering other high-risk types is of importance for prevention of all cervical malignancies [4].