scholarly journals Residual or Recurrent Precancerous Lesions After Treatment of Cervical Lesions in Human Immunodeficiency Virus–infected Women: A Systematic Review and Meta-analysis of Treatment Failure

2019 ◽  
Vol 69 (9) ◽  
pp. 1555-1565 ◽  
Author(s):  
Pierre Debeaudrap ◽  
Joelle Sobngwi ◽  
Pierre-Marie Tebeu ◽  
Gary M Clifford
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Human Immunodeficiency Virus ◽  
Treatment Failure ◽  
Post Treatment ◽  
High Grade ◽  
Cervical Lesions ◽  
Pooled Prevalence ◽  
Increased Risk ◽  
Immunodeficiency Virus

Abstract Background Screening and treating premalignant cervical lesions (cervical intraepithelial neoplasia 2+ [CIN2+]) is an effective way to prevent cervical cancer, and recommendations exist for the monitoring of treatment success. Yet, there is no specific recommendation for human immunodeficiency virus (HIV)-infected women, who are at a known, increased risk of cervical cancer. Methods A systematic review was performed by searching MEDLINE, EMBASE, and Web of Science for studies published from January 1980 through May 2018. Eligible studies described the prevalence of histologically- and/or cytologically-defined lesions in HIV-infected women at least 6 months post-treatment. The primary endpoint was treatment failure, defined as the presence of residual and/or recurrent high-grade CIN2+/high-grade squamous intraepithelial lesions post-treatment. The pooled prevalence in HIV-infected women and the odds ratios (ORs) for HIV-infected compared to HIV-uninfected women were estimated using random-effects models. Results Among 40 eligible studies, the pooled prevalence of treatment failure in HIV-infected women was 21.4% (95% confidence interval [CI] 15.8–27.0). There was no significant difference in the treatment failure prevalence for cryotherapy (13.9%, 95% CI 6.1–21.6) versus loop electrosurgical excision procedure (13.8%, 95% CI 8.9–18.7; P = .9), but the treatment failure prevalence was significantly higher in women with positive (47.2%, 95% CI 22.0–74.0) than with negative (19.4%, 95% CI 11.8–30.2) excision margin (OR 3.4, 95% CI 1.5–7.7). Treatment failure was significantly increased in HIV-infected versus HIV-uninfected women, both overall (OR 2.7, 95% CI 2.0–3.5) and in all sub-group analyses. Conclusions There is strong evidence for an increased risk of treatment failure in HIV-infected women, in comparison to their HIV-negative counterparts. The only significant predictor of treatment failure in HIV-infected women was a positive margin status, but further data is needed on long-term outcomes after ablative treatment in HIV-infected women.

Human Papillomavirus Vaccination Prior to Loop Electroexcision Procedure Does Not Prevent Recurrent Cervical High-grade Squamous Intraepithelial Lesions in Women Living With Human Immunodeficiency Virus: A Randomized, Double-blind, Placebo-controlled Trial

2020 ◽  
Author(s):  
Cynthia Firnhaber ◽  
Avril Swarts ◽  
Vuyokazi Jezile ◽  
Masango Mulongo ◽  
Bridgette Goeieman ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Human Immunodeficiency Virus ◽  
Human Papillomavirus ◽  
Hpv Vaccination ◽  
High Grade ◽  
Double Blind ◽  
Women Living With Hiv ◽  
Immunodeficiency Virus ◽  
Living With Hiv ◽  
Intraepithelial Lesions

Abstract Background Women living with human immunodeficiency virus (HIV), especially in sub-Saharan Africa, are at high risk for cervical high-grade squamous intraepithelial lesions (HSIL) and cervical cancer. These women have high HSIL recurrence rates after loop electroexcision procedure (LEEP). Retrospective studies suggest that human papillomavirus (HPV) vaccination improves response to treatment of cervical HSIL. Methods We performed a double-blind, randomized clinical trial enrolling 180 women living with HIV in Johannesburg, South Africa, diagnosed with cervical HSIL by colposcopic biopsy. Women received quadrivalent HPV vaccine or placebo (1:1) at entry, week 4, and week 26. LEEP was performed at week 4. Colposcopic-directed biopsies and cervical cytology were performed at weeks 26 and 52. The primary endpoint, cervical HSIL by histology or cytology at either week 26 or 52, was compared between arms using χ 2 analysis. Results Participant characteristics included median age of 39 years and median CD4 count 489 cells/μL, and 94% had HIV suppression. One hundred seventy-four women completed the vaccine/placebo series and had evaluable results at week 26 or 52. The proportion experiencing the primary endpoint was similar in the vaccine and placebo groups (53% vs 45%; relative risk, 1.18 [95% confidence interval, .87–1.6]; P = .29). HSIL recurrence was associated with a LEEP biopsy result of HSIL and detection of HSIL at the margins of the LEEP sample. Conclusions This study did not support HPV vaccination to prevent recurrent HSIL after LEEP in women living with HIV. Recurrent HSIL was high despite virologic suppression. Improved treatments are needed for HSIL to reduce the burden of cervical cancer among women living with HIV.

HIV-Tuberculous Meningitis Co-infection: A Systematic Review and Meta-analysis

2020 ◽  
Vol 21 ◽  
Author(s):  
Ali Purmohamad ◽  
Taher Azimi ◽  
Mohammad Javad Nasiri ◽  
Mehdi Goudarzi ◽  
Moein Zangiabadian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Human Immunodeficiency Virus ◽  
Tuberculous Meningitis ◽  
Preventive Measures ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Analysis Model ◽  
Pooled Prevalence ◽  
Immunodeficiency Virus ◽  
High Prevalence

: Human immunodeficiency virus (HIV)-infected persons are at a higher risk of developing Tuberculous meningitis (TBM). We aimed to estimate the prevalence of TBM-HIV co-infection. We systematically searched Pubmed/Medline, Embase and Cochrane library databases from January 1, 2000, to January 31, 2017, to find relevant studies. We employed the random-effects meta-analysis model to estimate the pooled prevalence of TBM-HIV co-infection. Twenty-six eligible studies showed the prevalence of HIV in TBM patients. In the pooled analyses, the prevalence of HIV was 30% (95% CI: 12-47) in patients with confirmed TBM, and 12.1% (95% CI: 7.3-19.2) in patients with suspected TBM. This study shows a high prevalence of TBM-HIV co-infection. Establishing proper diagnostic criteria and preventive measures for TBM infections could assist in the prevention and management of TBM infection, particularly TBM-HIV co-infection.

Radical hysterectomy for cervical cancer amongst women infected with the human immunodeficiency virus

2007 ◽  
Vol 17 (6) ◽  
pp. 1264-1265 ◽  
Author(s):  
M. Moodley
Keyword(s):  
South Africa ◽  
Cervical Cancer ◽  
Human Immunodeficiency Virus ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Invasive Cervical Cancer ◽  
Cervical Lesions ◽  
Stage Disease ◽  
Immunodeficiency Virus ◽  
Late Stage Disease

Invasive cervical cancer and human immunodeficiency virus (HIV) infection are an epidemic in South Africa. Most HIV-infected patients with cervical cancer present with late-stage disease. Whilst the literature describes the outcome of such women with preneoplastic cervical lesions, the management of early-stage invasive cervical cancer and HIV is lacking. We present our experience with such patients

The Positive Predictive Value of High-Grade Squamous Intraepithelial Lesion on Cytology for the Histological Diagnosis of Cervical Intraepithelial Neoplasia 2 or Higher: A Systematic Review

2019 ◽  
Vol 63 (3) ◽  
pp. 206-214 ◽  
Author(s):  
Nina Karia ◽  
Alison Van Loon ◽  
Cindy Simoens ◽  
Ina Benoy ◽  
Johannes Bogers
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Positive Predictive Value ◽  
Cervical Intraepithelial Neoplasia ◽  
Predictive Value ◽  
Intraepithelial Neoplasia ◽  
Histological Diagnosis ◽  
High Grade ◽  
Cervical Lesions ◽  
Intraepithelial Lesion

Cervical cancer is a major worldwide health problem. Therefore, regular cervical screening in order to make an early diagnosis can help to prevent cervical cancer, through identifying and treating preinvasive cervical lesions. The aim of this review is to evaluate the correlation between the cytological screening result and the final gold standard histological outcome in the diagnosis of cervical lesions. More specifically, the correlation between high-grade intraepithelial lesion (HSIL) on cytology and histological cervical intraepithelial neoplasia grade 2 or higher (CIN2+) was intended, by calculating the positive predictive value (PPV). PPV is an important value from a clinical point of view. An electronic search was carried out in the electronic databases MEDLINE (through PubMed) and the Cochrane Library (last searched beginning of December 2017), supplemented with the related article feature in PubMed and snowballing. Article selection (predefined inclusion and exclusion criteria) and data extraction were evaluated by two independent reviewers (N.K. and A.V.L.). After identifying 1,146 articles, 27 articles were finally included in this systematic review, representing 28,783 cytological HSIL diagnoses in total. The PPV of HSIL was 77.5% (range: 45.4–95.2%) for the histological diagnosis of CIN2+ and 55.4% (range: 36.4–67.6%) for the diagnosis of CIN3+. In this systematic review, 77.5% of the HSIL-positive women eventually had a CIN2+ diagnosis. The diagnostic value of a cytological HSIL result (conventional or liquid-based cytology) in the diagnosis of CIN2+ lesions is good, but a combination of tests could raise this value.

Food insecurity and its gender disparity among adult people living with Human Immunodeficiency Virus in Ethiopia: A systematic review and meta-analysis

2019 ◽  
Author(s):  
Dube Jara Boneya ◽  
Ahmed Ali Ahmed ◽  
Alemayehu Worku Yalew
Keyword(s):  
Systematic Review ◽  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Food Insecurity ◽  
Meta Analysis ◽  
Gender Disparity ◽  
Cochrane Library ◽  
Pooled Prevalence ◽  
Immunodeficiency Virus ◽  
Living With Hiv

Abstract Background People living with Human Immunodeficiency Virus may lack access to sufficient quantities of nutritious foods and are vulnerable to food insecurity. Studies suggest there is gender-based inequality in the experience of food insecurity. The few studies conducted on the prevalence of food insecurity among adults living with Human Immunodeficiency Virus in Ethiopia presented inconclusive findings. Therefore, the objective of the current systematic review and meta-analysis was to estimate the pooled prevalence of food insecurity and its gender disparity among adult patients living with HIV and receiving antiretroviral therapy in Ethiopia.Method We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The research databases PubMed, Google Scholar, CINAHL, PopLine, MedNar, Embase, Cochrane library, the JBI Library and the WEB OF SCIENCE were searched using keywords. We included studies reporting prevalence of food insecurity among adults aged greater than 18 years who were living with HIV and receiving antiretroviral therapy. The meta-analysis was conducted using STATA 14 software. A random effects model was used to estimate the pooled prevalence at 95% CI. Funnel plots and Egger’s and Begg’s tests were used to check for publication bias.Results A total of 52 studies representing 4031 adults were identified; eleven studies were included in the meta-analysis. The overall pooled estimated prevalence of food insecurity was 63.44% (95% CI: 46.33-80.54%). A higher pooled prevalence of food insecurity was observed among females (68.85%, 95% CI (57.88%, 79.81%)) compared to males (31.15%, 95% CI (20.19%, 42.12%)).Conclusion The review demonstrates a high prevalence of food insecurity among people living with HIV in Ethiopia, with evidence of greater vulnerability among women. Interventions should be culture and context specific to address regional and gender disparities in the prevalence of food insecurity.

Human Immunodeficiency Virus Positive status disclosure to a sexual partner and its determinant factors in Ethiopia. A systematic review and meta-analysis.

2020 ◽  
Author(s):  
Fikadu Ambaw Yehualashet ◽  
Eleni Tesfaye Tegegne ◽  
Mekbib Kassa Tessema ◽  
Mulualem Endeshaw
Keyword(s):  
Systematic Review ◽  
Human Immunodeficiency Virus ◽  
Meta Analysis ◽  
Hiv Positive ◽  
Hiv Status ◽  
Pooled Prevalence ◽  
Immunodeficiency Virus ◽  
Regression Test ◽  
Status Disclosure ◽  
Hiv Aids

Abstract Background: Disclosure of Human Immunodeficiency Virus positive status significantly reduced the transmission of HIV; yet, it remains a challenge for many HIV patients. Disclosure serves plays a crucial role to raise awareness and to reduce risky behaviors. Hence, this study aimed to determine the pooled prevalence and effect sizes of determinant factors of HIV positive status disclosure through a systematic review and meta-analysis of the results of the existing primary studies in Ethiopia. Method: This systematic review and meta-analysis was aimed to determine prevalence of HIV positive status disclosure and associated factors by considering and searching published primary articles from different sources. A sensitivity test was conducted to evaluate the presence of influential studies. Besides, the heterogeneity test has been conducted; and publication bias was examined through observing the funnel plot as well as objectively by interpreting the Egger’s regression test. Following the Egger’s regression test, P-value <0.05 was considered as statistically significant at 95% Confidence Interval. Result: A total of 18 primary studies were searched from different data sources. The overall pooled prevalence of HIV positive status disclosure among adult PLWHA in Ethiopia was indicated to be 75.95% (95% CI:69.93-81.98); the highest and lowest pooled estimated HIV status disclosure was in Amhara (82.78%) and Tigray (54.31%) regions respectively. Furthermore, Knowing the HIV positive status of sexual partner, AOR=19.66(95% CI: 10.19-37.91), having prior discussion about HIV testing with their partner, AOR=9.18(95% CI: 5.53-15.24), got Human Immunodeficiency Virus pretest counseling service AOR=4.29(95% CI: 2.56-7.21) and being a member of HIV/AIDS associations, AOR=3.34(95% CI: 2.17-5.12), were significantly associated with HIV positive status disclosure among People living With HIV/AIDS in Ethiopia.Conclusion: The pooled national estimate of HIV/AIDS positive status disclosure is low as compared to the WHO disclosure rate of developing countries and the findings of other national and international studies. Ministry of health and other stakeholders shall design new approaches and strategies to encourage disclosure of HIV status, educate the public about the negative impact of nondisclosure within family members. Health care providers working at Human HIV test centers shall emphasis extensive counseling on disclosure of status to a partner. Moreover, different stakeholders, health workers and community members shall establish, organize, and support HIV/AIDS Associations and motivate HIV positive people to be engaged and participated.

scholarly journals Human Immunodeficiency Virus Positive status disclosure to a sexual partner and its determinant factors in Ethiopia. A systematic review and meta-analysis.

2020 ◽  
Author(s):  
Fikadu Ambaw Yehualashet ◽  
Eleni Tesfaye Tegegne ◽  
Mekbib Kassa Tessema ◽  
Mulualem Endeshaw
Keyword(s):  
Systematic Review ◽  
Human Immunodeficiency Virus ◽  
Meta Analysis ◽  
Hiv Positive ◽  
Hiv Status ◽  
Pooled Prevalence ◽  
Immunodeficiency Virus ◽  
Regression Test ◽  
Status Disclosure ◽  
Hiv Aids

Abstract Background: Disclosure of Human Immunodeficiency Virus positive status significantly reduced the transmission of HIV; yet, it remains a challenge for many HIV patients. Disclosure serves plays a crucial role to raise awareness and to reduce risky behaviors. Hence, this study aimed to determine the pooled prevalence and effect sizes of determinant factors of HIV positive status disclosure through a systematic review and meta-analysis of the results of the existing primary studies in Ethiopia. Method: This systematic review and meta-analysis was aimed to determine prevalence of HIV positive status disclosure and associated factors by considering and searching published primary articles from different sources. A sensitivity test was conducted to evaluate the presence of influential studies. Besides, the heterogeneity test has been conducted; and publication bias was examined through observing the funnel plot as well as objectively by interpreting the Egger’s regression test. Following the Egger’s regression test, P-value <0.05 was considered as statistically significant at 95% Confidence Interval. Result: A total of 18 primary studies were searched from different data sources. The overall pooled prevalence of HIV positive status disclosure among adult PLWHA in Ethiopia was indicated to be 75.95% (95% CI:69.93-81.98); the highest and lowest pooled estimated HIV status disclosure was in Amhara (82.78%) and Tigray (54.31%) regions respectively. Furthermore, Knowing the HIV positive status of sexual partner, AOR=19.66(95% CI: 10.19-37.91), having prior discussion about HIV testing with their partner, AOR=9.18(95% CI: 5.53-15.24), got Human Immunodeficiency Virus pretest counseling service AOR=4.29(95% CI: 2.56-7.21) and being a member of HIV/AIDS associations, AOR=3.34(95% CI: 2.17-5.12), were significantly associated with HIV positive status disclosure among People living With HIV/AIDS in Ethiopia.Conclusion: The pooled national estimate of HIV/AIDS positive status disclosure is low as compared to the WHO disclosure rate of developing countries and the findings of other national and international studies. Ministry of health and other stakeholders shall design new approaches and strategies to encourage disclosure of HIV status, educate the public about the negative impact of nondisclosure within family members. Health care providers working at Human HIV test centers shall emphasis extensive counseling on disclosure of status to a partner. Moreover, different stakeholders, health workers and community members shall establish, organize, and support HIV/AIDS Associations and motivate HIV positive people to be engaged and participated.

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