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

Authors

  • Megan J. Huchko,

    Corresponding author
    1. Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
    • Correspondence to: Megan J. Huchko, MD, MPH, 50 Beale St, Ste 1200, San Francisco, CA 94105, USA, Tel.: +415-597-9318, Fax: +415-597-9300, E-mail: megan.huchko@ucsf.edu

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    • Conflicts of interest: Dr. Smith-McCune serves as the Founding Chair of the Clinical and Scientific Advisory Board of OncoHealth Inc and receives reimbursement for that role with stock options. The remaining authors have no financial disclosures or conflicts of interest to declare

  • Jennifer Sneden,

    1. Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
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  • George Sawaya,

    1. Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
    2. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
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  • Karen Smith-McCune,

    1. Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
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  • May Maloba,

    1. Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
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  • Naila Abdulrahim,

    1. Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
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  • Elizabeth A. Bukusi,

    1. Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
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  • Craig R. Cohen

    1. Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
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Abstract

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.

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