Page 354 - HIVMED_v21_i1.indb

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 4 Scientific Letter

Low CD4 count and educational status predict

abnormal cervical smears amongst HIV-positive

women initiating antiretroviral therapy

in South Africa

Authors: Introduction
Nondumiso Mthembu 1
Jienchi Dorward Cervical cancer is common amongst human immunodeficiency virus (HIV)-positive women in
1,2
Nivashnee Naicker 1 low- and middle-income countries. In South Africa, more than 7500 cases are diagnosed annually
Farzana Osman and over 50% result in death, making cervical cancer the leading cause of cancer mortality. South
1
1
Siphesihle Gumede 1
Yukteshwar Sookrajh Africa’s high HIV prevalence contributes to this high burden, because HIV-positive women are
3
Paul Drain 4,5,6 more likely to have persistent human papilloma virus (HPV) infection and precancerous cervical
Nigel Garrett changes. Cervical cancer is preventable either through HPV vaccination of girls before sexual
1,7
2
debut, which was rolled out in South Africa from 2014, or screening and treatment of precancerous
Affiliations:
1 Centre for the AIDS cervical lesions. South African guidelines recommend cervical screening for all HIV-positive
Programme of Research in women at HIV diagnosis and then every 3 years. 1
South Africa (CAPRISA),
University of KwaZulu-Natal,
Durban, South Africa Antiretroviral therapy (ART) causes immune reconstitution and may reduce the risk of cervical
cancer amongst HIV-positive women by lowering HPV acquisition, increasing HPV clearance
2
2 Nuffield Department of and slowing the progression to precancerous lesions. However, these effects may be diminished
Primary Care Health Sciences, for women who initiate ART at low CD4 counts. Since 2016, when universal test and treat (UTT)
3
University of Oxford, Oxford, 3
United Kingdom was introduced in South Africa, women began initiating ART at CD4 counts > 500 cells/mm
(early initiators) and may therefore be protected against precancerous cervical abnormalities and
3 Prince Cyril Zulu cancer. 3
Communicable Disease
Centre, eThekwini
Municipality, Durban, In this study, we aimed to assess whether early initiators of ART had a lower risk of abnormal
3
South Africa cervical smears when compared to late initiators (women with a CD4 ≤ 500 cells/mm ), after
introduction of UTT in South Africa.
4 Department of Global
Health, Schools of Medicine
and Public Health, University Methods
of Washington, Seattle, Study design
United States
We performed a cross-sectional analysis at enrolment into the Simplifying HIV TREAtment and
5 Department of Medicine, Monitoring (STREAM) study, a randomised trial assessing point-of-care viral load testing amongst
School of Medicine, 4,5
University of Washington, people living with HIV receiving ART (NCT03066128).
Seattle, United States
Participants and setting
6 Department of
Epidemiology, School of The STREAM study was conducted at the Prince Cyril Zulu Communicable Disease Centre
Public Health, University of (PCZ CDC), a large public clinic in central Durban, South Africa. At PCZ CDC, all women who test
Washington, Seattle,
United States HIV-positive are referred for ART initiation and have CD4 cell count and Papanicolaou cervical
smear testing performed using routine National Health Laboratory Services (NHLS). We enrolled
non-pregnant, HIV-positive adults aged 18 years or older who were clinically stable on first-line
ART for 6 months, and randomised them to receive point-of-care viral load monitoring and task-
shifting to an enrolled nurse or standard laboratory monitoring and professional nurse care.
4
7 Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
Corresponding author: Jienchi Dorward , [email protected]
Read online: Project Research Number: NCT03066128
Read online:
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Scan this QR Dates: Received: 18 Nov. 2019 | Accepted: 22 Jan. 2020 | Published: 30 Mar. 2020
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mobile device amongst HIV-positive women initiating antiretroviral therapy in South Africa. S Afr J HIV Med. 2020;21(1), a1045. https://doi.org/10.4102/
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Copyright: © 2020. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
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