Comparison of visual inspection with acetic (VIA) results and cervical leep biopsy histological results in a population stratified by HIV status in Harare, Zimbabwe

Abstract

Background: VIA is a non-specific cervical cancer screening test as it causes false positives in other non-neoplastic conditions such as cervicitis. It is therefore necessary to histologically analyze the tissue excised by LEEP to determine the type of lesion the patient had and to screen those that may need further oncology treatment. HIV positive women are more likely to harbor more serious VIA positive cervical lesions than HIV negative women.

Objectives: To compare VIA and LEEP histology results in a population stratified by HIV status and to compare the PPV of VIA in HIV positive and HIV negative women.

Study design: Cross sectional descriptive study.

Setting: Cimas Medical Laboratories.

Subjects: VIA positive women who were treated by LEEP and had LEEP biopsies collected during the procedure.
Materials and Methods: VIA was performed by the application of 3-5% acetic acid on the cervix. Aceto-white areas on the cervix were excised using a hot wire loop and sent to the laboratory for analysis. The tissues were processed in a Citadel 2000 tissue processor and stained using the manual H&E staining protocol. A pre-designed data collection was used to collect data on variables such as age, HIV status, VIA results and LEEP histology results. The mean age of patients with neoplastic and non-neoplastic lesions was compared using an independent t-test. A p-value <0.05 was regarded as statistically significant.

Results: A total of 412 VIA positive women: 326 HIV+ and 86 HIV- were recruited into the study. The mean (SD) age of the study participants was 40.6 (9.1)years, and the range was 18-89 years. The most frequent LEEP biopsy histology diagnoses were HSIL (47%) and cervicitis (48%) in the HIV+ and HIV- groups respectively. The PPV of VIA was 51.5% (95% CI: 48.9 to 54.1) and 18.6% (95% CI: 17.7 to 19.5) in HIV+ and HIV- patients respectively. The mean ages of patients with non-neoplastic lesions (26.9 years) and neoplastic lesions (44.8 years) were statistically different, p = 0.043.

Conclusions: The majority of VIA positive lesions were neoplastic and non neoplastic in HIV+ and HIV- women respectively.VIA predicts neoplastic lesions (≥ HSIL) better in HIV+ patients than in HIV - patients.

Recommendation: HIV+ women should be prioritized to get treatment services for VIA positive lesions ahead of HIV negative women as they are more likely to harbor more serious lesions (≥ HSIL).