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Adebamowo Clement
JAIDS Journal of Acquired Immune Deficiency Syndromes: January 2016
doi: 10.1097/01.qai.0000479615.09526.a7
Abstract: PDF Only
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Cervical cancer is the second commonest cancer in Africa where it accounts for an estimated 92,340 new cases, an ASR of 33.4 per 100,000 and mortality rate of 21.5 per 100,000 in 2012. Persistent infection by high risk Human Papilloma Virus infection is a necessary but not sufficient cause of the disease and other factors eg, HIV infection and smoking play a role in cervical carcinogenesis. Studies from developed countries have identified HPV types 16 and 18 in more than 70% of all cervical cancer cases but probably accounts for less in African population. HPV infection is ubiquitous and some 80% of women are infected at some point in their lives. Nevertheless infection persists only in about 10% and leads to carcinogenesis in a minority of these. The limited data available from studies of HIV negative African women suggests that there is marked heterogeneity and high prevalence of multiple hrHPV types' infections in these populations. The proportional contribution of each of these hrHPV types, their likelihood of persistence and the aggregate contribution of multiple infections to cervical carcinogenesis in this population is not well characterized. While there is evidence for genetic predisposition to HPV infection, there has been no Genome-Wide Association Study (GWAS) of the genetic predispositions to persistent hrHPV infection to date. Recent developments in genomics and microbiomics also suggest a role for the vaginal microenvironment—the vaginal microbiome and cervical cytokines—in persistent infection but there are few studies of these. Despite these gaps in knowledge, developed countries have reduced incidence of cervical cancer by over 65% in the past 4 decades using a Pap smear, liquid cytology and most recently HPV DNA based testing. However these technologies have not translated well to developed countries where the incidence and mortality of cervical cancer is still similar to what it was in developed countries 50 years ago

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