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Co-morbidity of HIV and Cervical Cancer: A One Year Multicentric Pilot Study in Cameroon

Enow Orock GE, Takang W, Enow Orock A, Ewane TP, Egbe OT, Halle Ekane G and Mbu RE

Background: Although the national prevalence of HIV infection has reduced in the past few years in Cameroon, patients with HIV-related malignancies, especially cervical cancer are on the rise. There is enormous challenge in the management of these patients in our setting. Both diseases respectively and collectively, have a high morbidity and mortality. Few studies on the profile of patients with both HIV infection and cervical cancer have been carried out in our setting, whereas their Knowledge is essential in the short and long term management strategies for both diseases. This study was aimed at finding the factors associated with co morbidity of HIV and cervical cancer.

Objective: The main objective of this study was to find out the relationship between cervical cancer and HIV infection among patients in our community. Specifically we wanted to find out the transition time from HIV+ to HIV-cervical cancer amongst these patients.

Materials and Methods: This is a one year prospective, cross-sectional, multicentre pilot study from January to December 2015, in 5 hospitals across 3 regions of the country. Vital data on the patients and data concerning both HIV infection and cervical cancer respectively were assembled and analyzed.

Results: We found 66 patients with various malignant cervical lesions with a coinfection of HIV in this study. The patients ranged in age between 24 and 71 years and majority (63.6%) were aged 40 years and above, with 56% having attained at least a secondary education and majority were married (70%). The main finding was a squamous cell lesion which was invasive carcinoma (68.18%) or a dysplasia (16.66%). The commonest HIV serotype amongst patients was type 1 (66.7%), though in 18.2% of cases there was HIV type 1 and 2 co-infection. Majority of cases had CD4 counts below 400 cells/mm3. The average duration of the infection before apparition of cancer was 2.5 years. In all cases, cancer was diagnosed after HIV infection.

Conclusion: HIV and cervical cancer co morbidity prevalence is increasing in our community. Cervical cancer occurs within few years following HIV. The risk factors of these co-morbid conditions include infection by HIV serotype I, a low CD4 count, married women and a high educational level. This conclusion is in reserve of our sample size and in disregard of income factor amongst the patients.

Though a squamous cell lesion is more predominant, adenocarcinoma is also common in patients. Screening and treatment for cervical cancer and appropriate HIV management strategies should be instituted as soon as the infection is diagnosed. Cervical cancer surveillance should be intensified within the first few years following HIV infection.