Accuracy of visual inspection with acetic acid to detect cervical cancer precursors among HIV-infected women in Kenya

详细信息    查看全文

• 作者：Megan J. Huchko ; Jennifer Sneden ; George Sawaya ; Karen Smith-McCune ; May Maloba ; Naila Abdulrahim ; Elizabeth A. Bukusi and Craig R. Cohen
• 关键词：visual inspection with acetic acid ; HIV infection ; Kenya ; cervical cancer screening
• 刊名：International Journal of Cancer
• 出版年：2015
• 出版时间：15 January 2015
• 年：2015
• 卷：136
• 期：2
• 页码：392-398
• 全文大小：259K
• ISSN：1097-0215

文摘

Visual inspection with acetic acid (VIA) is becoming a more widely recommended and implemented screening tool for cervical cancer prevention programs in low-resource settings. Many of these settings have a high prevalence of HIV-infected women. We carried out a cross-sectional validation study to define the sensitivity, specificity and predictive values of VIA among HIV-infected women. Women enrolled in HIV care at the Family AIDS Care and Education Services clinic in Kisumu, Kenya, were recruited for participation. All participants underwent VIA followed by colposcopy performed by a second blinded clinician. At colposcopy, lesions suspicious for cervical intraepithelial neoplasia 2 or greater (CIN2+) were biopsied. Disease status was determined by final histopathologic diagnosis in women who underwent biopsies. A satisfactory colposcopy with no lesions was considered a negative result. From October 2010 to June 2012, 1,432 women underwent VIA and colposcopy. A total of 514 (35.7%) women had a positive VIA, and 179 (12.2%) had CIN2+ confirmed by colposcopically directed biopsy. Sensitivity, specificity, positive and negative predictive values of VIA for CIN2+ were 86.6, 71.6, 30.3 and 97.4%, respectively. Specificity, but not sensitivity, increased with older age. Among older women, sensitivity was affected by CD4+ count and use of antiretroviral therapy. Although they are impacted by age and immune status, test characteristics for VIA among HIV-infected women are similar to what has been reported for general populations. Recommendations to use VIA as a screening tool should not vary by HIV status.