1. Cervical Cancer: Experiences from a Cohort of HIV-infected Women Pascoe M, Magure T, Mudhokwani P et al Abstract: MOAB0202

2. Presentation Outline Background Objectives Methodology Results Conclusion and recommendations

3. Background Cervical carcinoma the most common malignancy in Zimbabwean women, is preventable Women living with HIV (WLWHIV) have higher prevalence of Human Papillomavirus (HPV) infection, & multiple subtypes including oncogenic HPV They are at risk of higher grade lesions, higher rates of recurrent & persistent cervical disease & invasive cervical cancer (ICC) Primary prevention with HPV vaccination is possible Secondary prevention includes screening & treatment of early lesions

4. Objectives This study was done in order to: Describe the prevalence of cervical disease in a cohort of women receiving care for HIV infection Provide evidence to support the need for cervical cancer screening for WLWHIV in Zimbabwe

5. Methodology Newlands Clinic provides comprehensive care & treatment for 5500 patients (60% female) Cervical cancer screening using visual inspection with acetic acid (VIA) method introduced for sexually active females VIA & appropriate treatment with either cryotherapy or loop electrosurgical excision procedure (LEEP) A record review of women undergoing initial cervical screening from Jan 2011 to Dec 2014 Assessment of women with VIA+ve lesions at initial screening (IS) & histological analysis of 326 biopsies was done

6. Results Percentage of Women with VIA Positive Lesions at IS Year 34.9% (314/899)2011 32.4% (439/1357)2012 31.0% (126/406)2013 33.0% (110/333)2014 The mean was 32.8 %

7. Histological Diagnosis Histological diagnosis of 326 biopsy specimens obtained during LEEP CIN I - 15.7% CIN II - 30.0% CIN III - 29.4% ICC - 2%

8. Conclusions & Recommendations Cervical disease (defined by VIA+ve) was present in 1/3 of women at initial screening Histology of 326 biopsy specimens showed moderate to severe dysplasia (CIN II & III) in 59.4% & ICC in 2% These data illustrate the high prevalence of cervical disease & support the need for cervical cancer screening as a mandatory component of care for all WLWHIV The urgency for HPV vaccination as primary prevention strategy is highlighted

9. Thank you for your attention