CCI seed grant - preventing cervical cancer in HIV infected women

HCJMRI and Prayas, Pune in collaboration and guidance from IARC, have initiated a project to prevent cervical cancer in HIV infected women with support from UICC through a CCI grant.

Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI) and Prayas, Pune, India in collaboration and guidance from the International Agency for Research on Cancer (WHO), have initiated a project to prevent cervical cancer in HIV infected women with support from UICC through a specific grant for cervical cancer interventions.

Invasive cervical cancer is an AIDS defining illness. Observational studies in different regions of the world indicate that Human Immunodeficiency Virus (HIV) infected women are at higher risk for oncogenic Human papillomavirus (HPV) infection and at 5- to 10-fold increased risk of developing cervical cancer. In spite of large burden of both HIV infection and cervical cancer, there are very few studies in India that have addressed the association between them and the ways and means to control the latest. This project proposal is intended to comprehensively address early detection and prevention of cervical cancer in HIV-infected women in low- and medium-resourced settings. The study will assess the clinical utility of different screening tests and effectiveness of different treatment methods, cold coagulation in particular, for preventing the progression of high-grade cervical lesions to invasive cancer.

HIV infected women are referred to HCJMRI clinic from Prayas, Institute of Infectious Diseases, Pune and many non-governmental organizations working for HIV positive women in Maharashtra. Women are counseled by trained counselors and demographic and medical information is obtained following a written informed consent. Women are screened using visual inspection with 5% acetic acid (VIA), visual inspection with Lugol’s iodine (VILI), cytology and HPV DNA testing using hybrid capture 2 (HC2) tests. All screened women undergo colposcopy, directed biopsy for colposcopic and other gross abnormalities and treatment using cold coagulation for precancerous lesions during a single visit. Women with precancerous lesions not suitable for ablative treatment with cold coagulation are referred for excisional treatment using loop electrosurgical excision procedure (LEEP). Those with cancers are referred for appropriate cancer directed treatment. As of 15th May 2011 over 700 women have been screened and around 85 women have been treated out of the 1150 HIV positive women targeted by this project.