Human immuno deficiency virus infection and invasive cervical cancer in South Africa, what has changed

Research report to be submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Masters of Medicine in the branch of Obstetrics and Gynaecology Johannesburg, 2017Introduction Cervical carcinoma is the second most common malignancy worldwide after carcinoma of the breast and most common in the developing world1,2. In Africa, the population of women who are 15 years and older is estimated to be 267.9 million with approximately 78 897 diagnosed with invasive cervical carcinoma annually and a 78% mortality1. Aim The aim of the study was to ascertain whether HIV sero-positive women in South Africa present with a more advanced disease of invasive cervical carcinoma than their HIV sero-negative counter parts as well as to assess the degree of immuno-suppression and its effect on the stage of the disease at initial presentation. Is there a difference between the studies done then and what is presented now? Methods This was a descriptive retrospective record review. A total of 1300 cases of cervical carcinoma were seen at Charlotte Maxeke Johannesburg Academic Hospital, Combined Oncology Clinic from 2009 to 2010. Variables analyzed were patient age, HIV status, ARV standing, CD4 count, parity, race, papsmear result, cell type FIGO staging. This was done using the SPSS (Statistical Package for Social Sciences) version 13. RESULTS The mean age of the patients analyzed was 50.74 +- 13.08. There were 436 (37.1%) HIV seropositive patients, with a mean CD4 count of 357.59 +- 361.15. The mean age of presentation for HIV sero-positive patients was 55.4 +- 11.8 and for sero-negative patients 42.1+- 9.5 (p=0.000). A majority of the patients presented with stage IIIB disease. The HIV status had no bearing on the stage of the disease at presentation (p=0.363), nor the degree of immunosuppression (p=0.999). Due to the HIV pandemic, sero-positive patients presented with invasive cervical carcinoma 10 years earlier than their sero-negative counterparts. Black patients were mostly affected when compared to other races with a (p= 0.004). Antiretroviral seemed to make no difference on clinical staging at presentation (p=0.152) Conclusion HIV sero-positive patients presented with invasive cervical carcinoma 10 years earlier than their sero-negative counterparts. The degree of immunosuppression and HIV sero-positivity has no bearing on severity of the disease.MT201