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Open Access Research article

Association between invasive cancer of the cervix and HIV-1 infection in Tanzania: the need for dual screening

Crispin Kahesa1, Julius Mwaiselage1, Henry R Wabinga2, Twalib Ngoma1, Joan N Kalyango34 and Charles AS Karamagi35*

Author Affiliations

1 Ocean Road Cancer Research Institute, P.O.Box 3592, Dar es Salaam, Tanzania

2 Department of Pathology, Makerere University, P.O.Box 7072, Kampala, Uganda

3 Clinical Epidemiology Unit, Makerere University, P.O.Box 7072, Kampala, Uganda

4 Department of Pharmacy, Makerere University, P.O.Box 7072, Kampala, Uganda

5 Department of Paediatrics and Child Health, Makerere University, P.O.Box 7072, Kampala, Uganda

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BMC Public Health 2008, 8:262  doi:10.1186/1471-2458-8-262

Published: 30 July 2008

Abstract

Background

Cancer of the cervix is the second commonest malignancy in females worldwide and is the leading malignancy among women in Tanzania. Cancer of the cervix has been strongly associated with Human Papilloma Virus (HPV) which is a sexually transmitted disease. However, the role of HIV-1 in the aetiology of cancer of the cervix is less clear. Studies suggest that HPV and HIV-1 infection are synergistic and therefore their dual occurrence may fuel increased incidence of cancer of the cervix and AIDS. We therefore conducted a study to determine the association between cancer of the cervix and HIV-1.

Methods

The study was carried out in Ocean Road Cancer Institute, Dar-es-salaam, Tanzania between January and March 2007. A hospital-based case control design was used to study 138 cases and 138 controls. The cases were consenting women 18 years and above with histologically confirmed squamous cell carcinoma of the cervix, while the controls were consenting non-cancer adult women attendants or visitors. The participants were counselled and tested for HIV-1 and interviewed to assess risk factors for cancer of the cervix and HIV-1. Estimation of risk was done by computing odds ratios and confidence intervals. Confounding and interaction between the factors were assessed using logistic regression.

Results

HIV-1 prevalence was much higher among the cases (21.0%) than among the controls (11.6%). In logistic regression, HIV-1 was associated with cancer of the cervix (OR = 2.9, 95% CI = 1.4–5.9). Among the cases the mean age was lower for HIV-1 infected (44.3 years) than HIV-1 uninfected women (54 years, p = 0.0001).

Conclusion

HIV-1 infection is associated with invasive cancer of the cervix. Resource-constrained countries with a high burden of HIV-1 and cervical cancer should adopt a high-risk approach that targets HIV-1 positive women for screening of cervical cancer initially by utilizing HIV/AIDS resources.