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Comparing Papanicolau smear, visual inspection with acetic acid and human papillomavirus cervical cancer screening methods among HIV-positive women by immune status and antiretroviral therapy

Purpose

Cervical cancer is one of the leading causes of death among women in Sub-Saharan Africa. In many countries, a single visit, screen-and-treat approach is recommended. The approach is simple. Using household vinegar, cotton swabs, and a good light source, Visual Inspection with Acetic Acid, or VIA, can detect pre-cancerous changes to the cervix. The reason for this approach is also simple. It is cost-effective, low-tech, easy to implement, and women don’t have to wait for lab results in order to receive treatment. One concern however is that this approach may not be effective for women who are co-infected with HIV. We addressed this concern by comparing VIA to other screening methods commonly used in the US: Papanicolau smear, HPV rapid test, and the gold-standard, colposcopy-directed biopsy for 500 HIV-infected women in Kenya. We found that Pap smear may be the optimal test if resources are available. For a screen-and-treat program, VIA is similar for all women under the age of 40 years, regardless of HIV status. For older women, VIA was less likely to detect pre-cancerous changes compared to the gold standard, cervical biopsy and where resources are available, coupling HPV test and VIA may improve detection of pre-cancerous chances to the cervix. 

Authors

Chung MH, McKenzie KP, De Vuyst H, Richardson BA, Farzana R, Pamnani R, Njoroge JW, Nyongesa-Malava E, Sakr SR, John-Steward GC, Mugo N. Comparing Papanicolau smear, visual inspection with acetic acid and human papillomavirus cervical cancer screening methods among HIV-positive women by immune status and antiretroviral therapy. AIDS 2013; 27:2909–19.