Cervical screening in Africa: discordant diagnosis in a double independent reading. DYSCER-CI Group.

Interobserver variation in the cytological diagnosis of cervical lesions poses a problem for public health screening programs. This study assessed the frequency of discordant diagnoses between two independent cytopathologists in the screening of African women. In Abidjan, Côte d'Ivoire, 2157 women were recruited from three outpatient gynecology clinics and screened for cervical abnormalities and genital and human immunodeficiency virus (HIV) infections. The degree of agreement between the cytopathologists was assessed by kappa statistics. The overall agreement was poor (kappa = 0.33); however, the degree of agreement increased with the severity of the lesions and was fairly good (kappa = 0.53) for high-grade and invasive lesions requiring curative treatment. Discordance was associated with HIV infection but not with genital infections. For a prevention program of cervical cancer in this African context, strategies must be developed to minimize errors in cervical screening. Particularly, HIV-infected women require a systematic rereading to reduce false-negative results.

Short-term follow up of cervical squamous intraepithelial lesions associated with HIV and human papillomavirus infections in Africa.

A prospective study in gynaecology clinics was conducted in Abidjan, Côte d'Ivoire, to assess the short-term evolution of squamous intraepithelial lesions (SILs). Of 94 women with a cytological diagnosis of SIL, 38 were infected with HIV. The average follow-up period after the initial smear was 5 months. Detection of human papillomavirus (HPV) by polymerase chain reaction (PCR) was performed at both the time of enrolment and final follow-up smear. There were 39 cases of persistent SILs. HIV-positive women had a higher percentage of persistent SIL (76%) than HIV-negative women (18%, relative risk (RR)=4.3, 95% confidence interval (CI) = 2.4, 7.7). SILs were more frequent among women infected with HPV at the time of enrolment or with persistent HPV infection, but these associations disappeared after adjusting for HIV serostatus. Spontaneous regression of SILs commonly occurs in HIV-negative African women. HIV-infected women with cervical dyskaryosis require gynaecology follow-up.

PIP: A prospective study was conducted in a gynecology clinic in Abidjan, Cote d'Ivoire, to assess the short-term evolution of cervical squamous intraepithelial lesions (SIL) associated with HIV and human papillomavirus (HPV) infections. Final analysis included 94 women with cytological diagnosis of SIL, who were seen for initial and follow-up smear control. All women underwent HIV antibody testing after pre-test counseling upon recruitment, and polymerase chain reaction was performed to detect HPV. Out of the 94 women, 38 were infected with HIV and 39 had persistent cases of SIL. HIV-positive women had a higher percentage of persistent SIL (76%) than those who were HIV-negative. SIL incidence was more frequent among women infected with HPV at the time of enrollment or with persistent HPV infection. This study concludes that if HPV infection plays a major role in cervical SIL, other factors contribute to the progression or regression of the lesion, particularly HIV-induced immunosuppression. Therefore, HIV screening should be offered to women with SIL, and specific gynecology follow-up should be conducted on HIV-infected women with cervical SIL in Africa.

Squamous intraepithelial lesions of the cervix, invasive cervical carcinoma, and immunosuppression induced by human immunodeficiency virus in Africa. Dyscer-CI Group.

BACKGROUND: Squamous intraepithelial lesions (SILs) of the cervix are associated with human immunodeficiency virus (HIV) infection, but multiple risk factors must be considered in this context. The authors performed a cross-sectional study to assess the prevalence of and the factors associated with SILs and invasive cervical carcinoma (ICC). METHODS: In Abidjan, Côte d'Ivoire, women were recruited from three outpatient gynecology clinics and screened for both cervical disease and HIV infection. A CD4 cell count was performed for HIV-infected women. RESULTS: A total of 2198 women were included in the study. The prevalence of HIV infection was 21.7%. Of the 2170 women who underwent a cervical screening, 254 (11.7%) presented with a dysplasia or neoplasia: 7.6% had low grade SILs (LSILs), 3.3% had high grade SILs (HSILs), and 0.8% had ICCs. In multivariate analyses, factors associated with these lesions were as follows: for LSILs, HIV-1 seropositivity, age <24 years, parity >1, consultation for genital infection, and no use of oral contraception in the past; for HSILs, HIV-1 seropositivity, chewing tobacco use, low educational level, and parity >1; and for ICCs, age >33 years, parity >3, and illiteracy. In women infected with HIV-1, the prevalence of LSILs increased with a decrease in CD4 cell count, whereas this relation was not found among patients with HSILs. ICCs were linked to HIV-2 infection, but not to HIV-1 infection, in univariate analysis. CONCLUSIONS: In Africa, the prevalence of SILs is high. The factors associated with precancerous and cancerous lesions are different. Cancers in women infected with HIV-1 often may not reach the invasive stage. These findings could have implications for cervical screening programs in the future.

Human papillomavirus and human immunodeficiency virus infections: relation with cervical dysplasia-neoplasia in African women.

Our study assessed the factors associated with cervical squamous intra-epithelial lesions (SILs) and invasive cervical cancer, with special attention to human immunodeficiency virus (HIV) and human papillomavirus (HPV) infections. Women from 3 outpatient gynecology clinics of Abidjan, Côte d'Ivoire, were screened for cervical abnormalities: 151 women with low-grade SILs and 151 controls, 60 with high-grade SILs and 240 controls, and 13 with invasive cancer and 65 controls were enrolled in 3 case-control studies. Controls were chosen at random among the women without lesions, with a frequency matching for age and center. We used the PCR method for the detection of cervical HPV DNA and the restriction fragment length polymorphism analysis for HPV typing. HIV antibody testing and CD4 cell count were performed. In multivariate analyses, factors associated with cervical lesions were: for low-grade SILs, HPV positivity, HIV-1 seropositivity and parity >3; for high-grade SILs, HPV positivity, chewing tobacco, HIV-1 seropositivity and illiteracy, and for invasive cancer, HPV positivity only. We found a diversity of HPV types associated with SILs. In HIV-1-infected women, SILs occurred at an early stage of HIV disease. Women infected with both HIV-1 and HPV were at much higher risk of SILs than women infected with each of these 2 viruses separately. Invasive cancer was linked to HIV-2 infection in univariate analysis only. Our results suggest that the relation of SILs with HIV-1 infection is mainly explained by HPV infection and that HIV-1-infected African women may not often reach the invasive stage of cervical cancer.

PIP: The factors associated with cervical squamous intraepithelial lesions (SILs) and invasive cervical cancer were assessed in case-control studies of women from 3 outpatient gynecology clinics in Abidjan, Ivory Coast. Enrolled were 151 women with low-grade SILs and 151 controls, 60 women with high-grade SILs and 240 controls, and 13 women with invasive cervical cancer and 65 controls. Human papillomavirus (HPV) was detected in 75% of the high-grade SILs and cancers compared to 20% in the age-matched control groups. In the multivariate analysis, low-grade SILs were associated with HPV positivity, HIV-1 seropositivity, and parity above 3; for high-grade SIL, these risk factors were HPV positivity, chewing tobacco, HIV-1 seropositivity, and illiteracy. Cervical cancer was associated only with HPV positivity. Women infected with both HPV and HIV-1 were at a significantly higher risk of SILs than women infected with only one of these two viruses. These findings suggest that the association of SILs with HIV-1 infection is primarily explained by HPV infection and that HIV-infected African women may not live to reach the invasive stage of cervical cancer. The feasibility of cervical screening directed preferentially to African women with a low educational level or multipara merits assessment.

Place de l'infection a chlamydia trachomatis dans les oligoasthenospermies a Abidjan

Dans le but de rechercher la prevalence de l'infection a chlamydia trachomatis dans les oligoasthenospermies a Abidjan; 58 patients africains; de sexe masculin; sans symptomes uretraux et presentant une oligoasthenospermie ont ete analyses. L'age moyen des patients etait de 34;8 ans et 55;17 avaient un antecedent de maladie sexuellement transmissible (uretrite d'etiologie non determinee). La presence de Chlamydia trachomatis a ete recherchee par la coloration de Giemsa et la technique Elisa. A l'examen direct (coloration de Gram); 79;3 pour cent des patients presentaient des signes d'uretrite (polynucleaires neutrophiles superieurs a 5 par champ X 1000). Parmi ceux-ci; 45;65 pour cent avaient des cellules a inclusion et 19 pour cent etaient positifs pour l'antigene chlamydia en Elisa. La severite de l'oligoasthenospermie; semble liee a l'infection a Chlamydia trachomatis et la place de Neisseria gonorrhoeae n'est pas negligeable (26 pour cent)

Interet de la cytologie urinaire dans le diagnostic des cancers vesicaux. [Lettre]

La cytologie urinaire est un examen non invasif; utile dans le diagnostic et dans la surveillance des tumeurs des voies extra-urinaires notamment vesicales. Cette etude retrospective a porte sur 151 prelevements d'urine provenant exclusivement du service d'Urologie du CHU de Cocody et adresses au Laboratoire de Cytologie de la Faculte de Medecine de 1980 a 1990. 20 dossiers (13;2 pour cent) ont ete retenus sur un seul critere: la presence de cellules malignes ou suspectes dans le prelevement urinaire. Au plan epidemiologique; les 20 malades etaient tous des adultes; dont la moyenne d'age etait de 52;8 ans. Le sexe masculin etait predominant (85 pour cent). La symptomatologie dominee par l'hematurie (100 pour cent) etait souvent associee a des lombalgies; une pollakiurie et/ou une dysurie (14 cas sur 20). Des oeufs de bilharzies n'ont pas ete retrouves. Au plan clinique; les diagnostics les plus souvent evoques etaient: les tumeurs vesicales (60 pour cent) et les tumeurs prostatiques avec extension vesicale (20 pour cent). Au plan cytologique; parmi les 20 prelevements retenus; 13 etaient des carcinomes evidents (carcinomes epidermoides vesicaux) et 7 ont paru suspects. L'examen histologique realise dans 7 cas (35 pour cent); a permis de confirmer 5 diagnostics cytologiques (71;42 pour cent) et de deceler 2 faux negatifs (28;57 pour cent). Les correlations cytoclinique: 91 pour cent et cyto-histologique: 71;4 pour cent etaient satisfaisantes pour les cancers vesicaux dans cette etude et ont permis aux auteurs de conclure que l'examen cytologique des urines dans la pathologie tumorale vesicale; demeure un moyen d'investigation fiable et sensible. Il apparait cependant important de sensibiliser les medecins et les auxiliaires de la sante; au bon conditionnement des prelevements afin d'eviter les problemes d'interpretation lies aux alterations cellulaires

[Turner syndrome: mosaic and isochromosome q in a young African woman]. / Syndrome de Turner: mosaïque et isochromosome q chez une jeune Africaine.

The authors describe the first case reported in Ivory Coast of an 18-year-old African girl for a small size and amenorrhea and failure to reach puberty. There was no dysmorphism. The uterus was infantile. X-ray examination of the skeleton revealed early osteoporosis and KOSOWICZ sign. Hormonal evaluation demonstrated hypertrophic hypogonadism. Diagnosis of TURNER's syndrome was confirmed by karyotype obtained by culture of peripheral blood and which was 46,Xi (Xq)/45,X, associating a mosaic and isochromosome q. Hormonal therapy induced menstruation and led to normal breast development. This case report confirms that these syndromes occur in Black Africa where diagnosis remains difficult due to the sophisticated facilities required.