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Cited by 33Cervical Cancer and HPV ResearchWomen's cancer prevention and managementReproductive tract infections research

Prevalence and Predictors of Colposcopic-Histopathologically Confirmed Cervical Intraepithelial Neoplasia in HIV-Infected Women in India

Open access
Sahasrabuddhe, Vikrant V., Bhosale, Ramesh A., Joshi, Smita N., Kavatkar, Anita N., Nagwanshi, Chandraprabha A., Kelkar, Rohini S., Jenkins, Cathy A., Shepherd, Bryan E. +4 more·2010·PLoS ONE
DOI 10.1371/journal.pone.0008634PMC PMC2798747
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Abstract

BACKGROUND: Prevalence estimates of cervical intraepithelial neoplasia (CIN) among HIV-infected women in India have been based on cervical cytology, which may have underestimated true disease burden. We sought to better establish prevalence estimates and evaluate risk factors of CIN among HIV-infected women in Pune, India using colposcopy and histopathology as diagnostic tools. METHODOLOGY: Previously unscreened, non-pregnant HIV-infected women underwent cervical cancer screening evaluation including standardized diagnostic colposcopy by a gynecologist. Histopathologic confirmation was conducted among consenting women with clinical suspicion of CIN. The prevalence of CIN was evaluated by a composite diagnosis based on colposcopy and histopathology results. Multivariable ordinal logistic regression analysis was conducted to determine independent predictors of increasing severity of CIN. RESULTS: The median age of the n = 303 enrolled HIV-infected women was 30 years (interquartile range, 27-34). A majority of the participants were widowed or separated (187/303, 61.7%), more than one-third (114/302, 37.7%) were not educated beyond primary school, and nearly two-thirds (196/301, 64.7%) had a family per capita income of <1,000 Indian Rupees ( approximately US$22) per month. Cervical high-risk HPV-DNA was detected in 41.7% (124/297) of participants. The composite colposcopic-histopathologic diagnoses revealed no evidence of CIN in 220 out of 303 (72.6%) women, CIN1 in 33/303 (10.9%), CIN2 in 31/303 (10.2%), CIN3 in 18/303 (5.9%) and 1 (0.3%) woman was diagnosed with ICC. Thus, over a quarter of the participants [83/303: 27.7% (95% CI: 22.7-33.1)] had > or =CIN1 lesions and a sixth [50/303: 16.5% (95% CI: 12.2-21.9)] had evidence of advanced (> or =CIN2) neoplastic disease. The independent predictors of increasing severity of CIN as revealed by a proportional odds model using multivariable ordinal logistic regression included (i) currently receiving antiretroviral therapy [adjusted odds ratios (aOR): 2.24 (1.17, 4.26), p = 0.01] and (ii) presence of cervical high-risk HPV-DNA [aOR: 1.93 (1.13, 3.28), p = 0.02]. CONCLUSIONS: HIV-infected women in Pune, India have a substantial burden of cervical precancerous lesions, which may progress to invasive cervical cancer unless appropriately detected and treated. Increased attention should focus on recognizing and addressing this entirely preventable cancer among HIV-infected women, especially in the context of increasing longevity due to antiretroviral therapy.

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  • HPV testing has practical advantages such as limited training requirements and the potential for self-sampling that ease the burden on healthcare resources, making it suitable for resource-limited settings.

    “Furthermore, practical advantages such as limited training requirements and the potential for self-sampling ease the burden on healthcare resources, making it suitable for resource-limited settings [22, 24–26].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [26]

    The Methods (Study Procedures; page unavailable) report that participants provided self-collected vaginal swabs for HPV testing. The Discussion (page unavailable) describes a push for low-cost, rapid HPV tests in developing countries, but says testing was then unavailable or unaffordable for most women there. The paper does not establish that HPV testing requires limited training or that these advantages reduce healthcare-resource burdens. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • In India, hrHPV prevalence exceeds 20% and HSIL+ lesions occur in over 5% of screened WLHIV.

    “Our findings align with prior studies in India, reporting hrHPV prevalence exceeding 20% and HSIL+ lesions in over 5% of screened WLHIV [21, 24, 26].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [26]

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Authors
Sahasrabuddhe, V. V., Bhosale, R. A., Joshi, S. N., Kavatkar, A. N., Nagwanshi, C. A., Kelkar, R. S., Jenkins, C. A., Shepherd, B. E., Sahay, S., Risbud, A. R., Vermund, S. H., & Mehendale, S. M.
Affiliations
  • Vanderbilt University (US)
  • National AIDS Research Institute (IN)
  • Tata Memorial Hospital (IN)
Corresponding author
Sahasrabuddhe, Vikrant V.
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2010-01-08
Volume
5
Issue
1
Pages
e8634
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0008634
PMC
PMC2798747
OpenAlex
W2001563463
Cited by
33
References
0
Citations by year
2025: 1 · 2024: 1 · 2022: 3 · 2019: 2 · 2018: 1 · 2017: 1 · 2016: 5 · 2015: 4 · 2014: 4 · 2013: 1 · 2012: 4
FWCI
2.57
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Indian Council of Medical Research
  • National Institutes of Health
  • National Cancer Institute (R21CA113465)
  • National Institute of Allergy and Infectious Diseases (P30 AI 54999, P30AI054999)
  • Fogarty International Center (D43TW001035)
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Keywords
cervical intraepithelial neoplasia, women living with HIV, high-risk HPV, cervical cancer screening, colposcopy, socioeconomic factors, India, Pune, cervical cancer burden
MeSH terms
Adult, Uterine Cervical Dysplasia, Colposcopy, Female, Humans, India, Prevalence

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