Comparison of visual inspection of the cervix with acetic acid (VIA) and pap smear among HIV-infected women in Phnom Penh, Cambodia
Lim, K Harwell, J De Munter, Paul Thay, S Srey, P Haverkamp, M Tharpe, L Jacques, G Lynen, L Cu-Uvin, S #
International AIDS Conference location:Toronto, Canada date:2006
Background: HIV-infected women are at high risk for cervical dysplasia/cancer. Pap smear screening is not available or feasible in many resource poor countries. We sought to evaluate the performance of VIA for cervical dysplasia/cancer screening in comparison with Pap smear.
Methods: 268 HIV-infected women were screened simultaneously by a physician for Pap smear and VIA from January to December 2005 in a Women´s HIV clinic in Cambodia. Household vinegar was applied to the cervix under illumination and magnified by digital camera after 2-3 minutes. VIA were graded as negative acetowhite (normal) or positive acetowhite (low grade, HPV, or high grade). Pap smears were read by telepathology at the University of Basel, Switzerland Pathology Department based on the Bethesda classification.
Results: Demographics of the women: mean age = 32 yrs (18-53), mean CD4 count = 282/mm3 (2-1221), 117/268 (44%) were on HAART. No data was available for 8 patients. Out of the 260 women, 205 (79%) were diagnosed as normal on VIA and Pap smear. 15 (5.8%) were positive on both VIA and Pap smear (11 concordant, 4 non-concordant). 34 (13%) were positive by VIA only (2 HPV, 22 low grade, 10 high grade) and 6 (2.3%) were positive by Pap smear only (1 HPV, 4 low grade, 1 high grade). The sensitivity of VIA was 71%. The specificity was 86%. Positive predictive value was 31% and negative predictive value was 97%. Mean CD4 among patients with high-grade lesions by VIA was 148.
Conclusions: VIA appears to be a reasonable screening tool for cervical abnormalities among HIV-infected women in resource limited settings where Pap smears are not readily available. Under these circumstances, we believe that abnormal VIA results should be followed by colposcopy or biopsy for confirmation. Further studies to compare VIA results with histology (colposcopy and biopsy) are essential.