Evaluation of Human Papilloma Virus as a Risk Factor for Cervical Cancer in Human Immunodeficiency Virus Positive Women

BACKGROUND : Cervical cancer (CC) is the fourth most common cancer worldwide and the most common cancer among women , a disease which is both preventable and treatable. Women with HIV, are more likely to have persistent HPV infections and more rapid progression to pre-cancer and cancer. World Health Assembly in 2020 – calls for 70% of women globally to be screened regularly for cervical disease with a high-performance test, and for 90% of those needing it to receive appropriate treatment. Alongside vaccination of girls against the human papillomavirus (HPV), implementing this global strategy could prevent more than 62 million deaths from cervical cancer in the next 100 years. AIMS AND OBJECTIVES: 1. To study the incidence of HPV (16, 18) infection in HIV positive women. 2. To determine the associated cervical lesions in HPV infected HIV positive women. 3. To encourage frequent screening for prevention of Cancer cervix in HIV positive women in the background of HPV infection. MATERIALS AND METHODS: Any HIV positive woman attending the Gynaecology OPD over the study period fulfilling the inclusion and exclusion criteria will be recruited in the study. After obtaining consent, elaborate history of the disease is taken and Gynaecological Examination and colposcopy was performed Cervical swab and high vaginal swab taken, labelled, Stored and Transported as per protocol Disposing the waste as per Bio medical Waste management. RESULTS: In this study, we found that around 78 (39%) of participants with HIV positive had HPV positive status. more than half of the study participants had an age group between 41-50 years, Almost three fourth (75%) were belonging to the lower class according to the Modified BG Prasad scale. Nearly 15% had a comorbidity present, of which Diabetes and Hypertension were the most commonly seen. With respect to the duration of HIV infection, we found that almost 87% had HIV infection for more than 10 years, while almost only one patient deferred from ART. Among the HIV positive women around 78 women had HPV positivity as per our gold standard RT-PCR, while around 37 (18.5%) and 68 (34%) were positive using high vaginal swabs and cervical swabs. Thus, in our study, we found that there were more of cervical swab +ve cases, followed by both positive and high vaginal swab +ve cases. With respect to the HPV positivity, we found that around 71 (35.5%) and 14 (7.0) were positive for HPV-16 and HPV-18 respectively. Affirming the higher association of HPV 16 infection in HIV positive women as well. Of 78 HPV positive cases, around 33 cases were positive for colposcopic findings accounting for 42%. categorising further, 28 /33 cases were CIN 1 accounting 35% of all abnormal colposcopic findings. 3 cases wer CIN 2 accounting 3%, 2 cases were CIN 3 accounting about 2% of all HPV positive cases CONCLUSION: Cancer cervix is a preventable disease and HPV infection is strongly implicated in the pathogenesis of Cancer cervix. The pattern of Acquisition, Persistence, disease clearance or progression of HPV infection in HIV positive population calls for Screen, triage and treat approach as recommended by WHO. 1. HPV, DNA as a primary screening test. 2. Starting at the age of 25. 3. Frequent screening – every 3 to 5 years screening interval. 4. Preventive vaccines against HPV are safe and immunogenic: they should be implemented in HIV infected population