Age-specific prevalence of human papilloma virus infection among Nigerian women

Background: Inconsistent trends in HPV prevalence by age have been described in Africa. We examined the age prevalence pattern and distribution of 37 HPV-DNA types among urban Nigerian women. Methods: The study population was a sample of 278 women who presented to cervical cancer screening programs in Abuja, Nigeria, between April and August 2012. Using a nurse administered questionnaire, information on demographic characteristics and risk factors of cervical cancer was collected and samples of cervical exfoliated cells were obtained from all participants. Roche Linear Array HPV Genotyping Test® was used to characterize prevalent HPV and log-binomial regression models were used to examine the association between potential correlates and the prevalence of HPV infection. Results: The mean age (SD) of the women enrolled was 38 (8) years. The overall prevalence of HPV was 37%. HPV 35 was the most prevalent HPV type in the study population. Among women age ≤ 30 years, 52% had HPV infection compared to 23% of those women who were older than 45 years (p = 0.006). We observed a significant linear association between age and the prevalence of HPV infections. The prevalence ratio (PR) and 95% confidence interval (CI) was 2.26 (1.17, 4.34) for any HPV infection, 3.83 (1.23, 11.94) for Group 1 HPV (definite carcinogens), and 2.19 (0.99, 4.84) for Group 2a or 2b HPV (probable or possible carcinogens) types, among women aged 18–30 years, compared to women who were older than 45 years. Conclusion: The prevalence of HPV infection was highest among younger women and decreased steadily with age among this population of urban Nigerian women

Evaluation of neuronal inflammation and oxidative DNA damage in different haptoglobin phenotypes of Nigerian type-2 diabetes mellitus population

Background: Oxidative stress is a major factor in the pathogenesis and progression of the clinical condition type 2 Diabetes Mellitus (DM) related to adverse biochemical/molecular interactions. Aim and Objectives: To determine whether haptoglobin phenotypes predispose DM patients to vascular complications and neuronal damage. Material and Methods: A total of 74 subjects were assessed out of which 31 had treated and untreated diabetes complicated with hypertension, 26 had treated and untreated uncomplicated DM and 17 were apparently healthy subjects who served as controls. Body Mass Index (BMI), Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP), serum Glucose (GLU), protein S100B and 8-Hydroxy-2-deoxyguanosine (8-OHdG) were determined in all subjects alongside the characterization of Haptoglobin (Hp) phenotypes. Results: BMI, SBP, DBP, GLU, protein S100B and 8-OHdG in treated and untreated complicated and uncomplicated DM patients were higher when compared to controls (p < 0.05). Hp 2 allele (Hp 2-1 and Hp2-2) was seen to be associated with poor glucose control, higher blood pressure and increased neuronal damage in both complicated and uncomplicated DM. It was also seen that the possession of Hp 2 gene was associated with a lower response to treatment. Conclusion: The Hp 2 allele could be a predisposing factor in developing diabetes related complications like hypertension and neuronal damage

HIV associated high-risk HPV infection among Nigerian women

Background: In developed countries, the incidence of cervical cancer has remained stable in HIV+ women but the prevalence and multiplicity of high-risk HPV (hrHPV) infection, a necessary cause of cervical cancer, appears different comparing HIV+ to HIV- women. Little is known about HIV and HPV co-infection in Africa. Methods: We enrolled women presenting at our cervical cancer screening program in Abuja, Nigeria between April and August 2012, and collected information on demographic characteristics, risk factors of HPV infection and samples of exfoliated cervical cells. We used Roche Linear Array HPV Genotyping Test® to characterize prevalent HPV and logistic regression models to estimate the association between HIV and the risk of hrHPV infection. Results: There were 278 participants, 54% (151) were HIV+, 40% (111) were HIV-, and 6% (16) had unknown HIV status. Of these, data from 149 HIV+ and 108 HIV- women were available for analysis. The mean ages (±SD) were 37.6 (±7.7) years for HIV+ and 36.6 (±7.9) years for HIV- women (p-value = 0.34). Among the HIV+ women, HPV35 (8.7%) and HPV56 (7.4%) were the most prevalent hrHPV, while HPV52 and HPV68 (2.8%, each) were the most prevalent hrHPV types among HIV- women. The multivariate prevalence ratio for any hrHPV and multiple hrHPV infections were 4.18 (95% CI 2.05 – 8.49, p-value <0.0001) and 6.6 (95% CI 1.49 – 29.64, p-value 0.01) respectively, comparing HIV + to HIV- women, adjusted for age, and educational level. Conclusions: HIV infection was associated with increased risk of any HPV, hrHPV and multiple HPV infections. Oncogenic HPV types 35, 52, 56 and 68 may be more important risk factors for cervical pre-cancer and cancer among women in Africa. Polyvalent hrHPV vaccines meant for African populations should protect against other hrHPV types, in addition to 16 and 18

Influence of Spirituality and Modesty on Acceptance of Self-Sampling for Cervical Cancer Screening.

INTRODUCTION: Whereas systematic screening programs have reduced the incidence of cervical cancer in developed countries, the incidence remains high in developing countries. Among several barriers to uptake of cervical cancer screening, the roles of religious and cultural factors such as modesty have been poorly studied. Knowledge about these factors is important because of the potential to overcome them using strategies such as self-collection of cervico-vaginal samples. In this study we evaluate the influence of spirituality and modesty on the acceptance of self-sampling for cervical cancer screening. METHODOLOGY: We enrolled 600 participants in Nigeria between August and October 2014 and collected information on spirituality and modesty using two scales. We used principal component analysis to extract scores for spirituality and modesty and logistic regression models to evaluate the association between spirituality, modesty and preference for self-sampling. All analyses were performed using STATA 12 (Stata Corporation, College Station, Texas, USA). RESULTS: Some 581 (97%) women had complete data for analysis. Most (69%) were married, 50% were Christian and 44% were from the south western part of Nigeria. Overall, 19% (110/581) of the women preferred self-sampling to being sampled by a health care provider. Adjusting for age and socioeconomic status, spirituality, religious affiliation and geographic location were significantly associated with preference for self-sampling, while modesty was not significantly associated. The multivariable OR (95% CI, p-value) for association with self-sampling were 0.88 (0.78-0.99, 0.03) for spirituality, 1.69 (1.09-2.64, 0.02) for religious affiliation and 0.96 (0.86-1.08, 0.51) for modesty. CONCLUSION: Our results show the importance of taking cultural and religious beliefs and practices into consideration in planning health interventions like cervical cancer screening. To succeed, public health interventions and the education to promote it must be related to the target population and its preferences

Abnormal cytology in HIV-positive women referred for colposcopy: an analysis of cytology-colposcopy-histology correlation

Context: HIV/AIDS is thought to facilitate the development of cervical neoplasia. Concern has been expressed about the efficiency of standard screening and treatment procedures in HIV/AIDS patientsObjective: The objective of the study was to examine the performance of standard modalities of cervical cancer screening and management in Human Immunodeficiency Virus (HIV) positive women. Method: A retrospective review of case records of HIV positive women referred to the colposcopy clinic of a tertiary referral centre in Cape Town, South Africa was done to correlate the cytologic referral findings with colposcopic evaluation and histological diagnosis of biopsy samples. Findings at subsequent follow-up examinations were also evaluated to assess efficacy of treatment or disease progression. Result: A total of 77 patients, aged 20 to 55 with a mean age of 30.34 [SD: 6.86] years, constituted the study group. There was agreement between cytological and colposcopic findings in 53% and 69% of low-grade (LG) and highgrade (HG) squamous intraepithelial lesions (SIL) respectively. Only in 6% of patients did colposcopy find a highergrade lesion than cytology. Histological samples were available for 58 of the 77 patients and the agreement between cytology and histology for HGSIL and LGSIL were 63.9% and 76.2% respectively. On follow-up for 3-24 (median: 8)months, 18% of LGSIL progressed to HGSIL, 63.6% remained stable and 18.2% regressed. Nearly 70% of patients with HGSIL remained lesion-free, 23% showed persistent disease and one patient progressed to invasive carcinoma during follow-up.Conclusion: Standard modes of conservative management provide satisfactory results in the management of HIV seropositive women with abnormal Pap smears. Keywords: HIV, cytology, colposcopy, cervical biopsyTropical Journal of Obstetrics and Gynaecology Vol. 22(2) 2005: 129-13