Dr Donta said that lower levels of awareness on cervical cancer and pap-smear screening is an important barrier to cancer control.
Among this cohort of couples, 32.3% women had HPV infection, 27% had bacterial vaginosis (BV), 8.3% had monilia fungus infection, 7.9% had chlamydia, and 0.5% had trichomonas vaginalis.
DOUBLE TROUBLE: HPV and HIV CO-INFECTION
Dr Smita Joshi said to Citizen News Service (CNS) that not only those who are HPV infected have increased risk of HIV acquisition but women living with HIV too have an increased risk of HPV infection of multiple strains, and it is more likely that HPV infection may persist for long, leading to cervical intraepithelial neoplasia (CIN) and cervical cancer too. Studies show that women living with HIV have 2-22% increased risk of cervical cancer.
PAP SMEAR, HPV DNA TEST, VIA
Dr Joshi cautioned that pap smear is not a very sensitive test as its sensitivity varies between 40-60%. There is a 50% chance of missing abnormality, she said. She strongly recommended HPV DNA test as it is the most objective test and other tests are somewhat subjective.
Dr Joshi also stressed that using visual inspection with acetic acid (VIA), popularly known as table vinegar, to identify precancerous cervical lesions and provide treatment at the same visit using a freezing technique called cryotherapy, works wonders in resource-limited settings like ours. A randomized controlled trial conducted in Tata Memorial Hospital showed that VIA resulted in 31% reduction in cervical cancer incidence. Dr Joshi added that VIA is not only simple and low cost test but consumables too do not cost more than INR 25-30 (less than USD 0.5). VIA can be performed by a trained healthcare worker or a nurse, has an improved sensitivity if followed by cytology, and results are available immediately. It offers an opportunity to begin treatment at the same clinic visit. However it may result in some overtreatment but overall is beneficial in terms of public-health outcomes.
Dr Joshi also highlighted that VIA performs better in HIV-infected women as compared to cytology probably due to large lesions that are fairly common in our setting. VIA-based screening is a practical and feasible approach for HIV-infected women. She agreed with Dr Palefsky that HPV vaccines are safe and immunogenic in HIV-infected girls and young women.
Bobby Ramakant, Citizen News Service -- CNS
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