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Screening of cervical neoplasia in HIV-infected women in India

Joshi, Smita; Sankaranarayanan, Rengaswamy; Muwonge, Richard; Kulkarni, Vinay; Somanathan, Thara; Divate, Uma

doi: 10.1097/QAD.0b013e32835b1041
Epidemiology and Social

Objective: To evaluate an accurate, affordable, and feasible method to screen and treat HIV-infected women so that cervical cancer can be prevented among them.

Design: A cross-sectional study was conducted in India in which eligible HIV-infected women underwent visual inspection with acetic acid (VIA), visual inspection with Lugol's iodine (VILI), cytology, human papillomavirus (HPV) testing, and colposcopy.

Methods: We screened women with cytology, HPV testing, VIA, and VILI. All screened women had colposcopy and women with colposcopic abnormalities had directed biopsies. Women with suspected cervical intraepithelial neoplasia (CIN) on colposcopy were treated with cold coagulation or loop excision. Sensitivity, specificity, and predictive values of the screening tests were calculated.

Results: Among 1128 women screened, 55 (4.9%) had CIN2–3 lesions. Sensitivity for VIA, VILI, cytology at atypical squamous cells of undetermined significance (ASCUS) threshold and HPV testing was 83.6, 89.1, 63.3, and 94.6%, and specificity was 88.8, 89.3, 94.5, and 77.4%, respectively, in detecting CIN2/3 lesions. Cytology had significantly lower sensitivity and higher specificity than VIA, VILI, and HPV testing. Sequential testing with VIA/VILI, HPV testing/VIA, HPV testing/VILI, and HPV testing/VIA/VILI had more balanced sensitivity and specificity than the single tests. Cold coagulation was well tolerated and cured 80% of CIN2–3 based on preliminary results at 6-month to 1-year follow-up periods.

Conclusions: Sequential testing with VIA and VILI is the most feasible screening approach for cervical cancer screening in HIV-infected women in low-resource countries. When HPV testing becomes feasible and affordable, HPV testing followed by VIA/VILI may be considered.

aHirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital Premises, Pune, Maharashtra, India

bEarly Detection & Prevention Section and Screening Group, International Agency for Research on Cancer, Lyon, France

cPrayas Health Group, Amrita Clinic, Athwale Corner, Karve Road, Deccan Gymkhana, Pune

dDivision of Pathology, Regional Cancer Centre, Trivandrum, India.

Correspondence to Dr R. Sankaranarayanan, Head, Early Detection and Prevention Section (EDP), International Agency for Research on Cancer (IARC), 150 cours Albert Thomas, 69372 Lyon Cedex 08, France. Tel: +33 4 7273 8599; fax: +33 4 7273 8518; e-mail:

Received 13 July, 2012

Revised 1 October, 2012

Accepted 5 October, 2012

Copyright © 2013 Wolters Kluwer Health, Inc.