Wendy Dhlomo-Mphatswe (South Africa)
University of KwaZulu-Natal Obstetrics and GynaecologyPresenter of 3 Presentations
POOR TREATMENT OUTCOME OF PRECANCEROUS CERVICAL LESIONS IN HIV POSITIVE WOMEN IS ASSOCIATED WITH T HELPER CELL TYPE 2 CYTOKINE SKEWING. (ID 1356)
Abstract
Introduction
Persistent infection with the human papilloma virus (HPV) leads to precancerous lesions and increased risk of cervical cancer if untreated. Surgical excision treatment failure and recurrence is high in HIV positive women.This study aims to investigate the behavioral, virological and immunological factors associated with treatment outcomes of lesions in HIV positive women.
Methods
A prospective cohort study based in Durban, South Africa recruited 200 women with precancerous cervical lesions between October 2016 and August 2018. The endpoint is outcomes of precancerous lesions at 12 months post-excision. Twenty cases (treatment failure) and controls (clearance) of patients matched for HPV 16/18 subtypes, CD4 count and age were selected. Concentrations of 27 pro-inflammatory, anti-inflammatory and regulatory cytokines were measured in cervicovaginal lavage (CVL) and plasma.
Results
There was no significant difference in any CVL cytokine between treatment responders and non-responders. Plasma concentrations of IL-4, IL-5, IL-7, IL- 10 and IL-17 were significantly higher in treatment failures compared to those with good outcomes (all p < 0.05). In multivariate linear regression analysis, the number of sexual partners as well as plasma IL-10 and IL-4 remained significantly associated with treatment failure?
Conclusions
A T helper (Th) 2 skewing at surgical treatment is associated with poor treatment response and possibly represents a diversion from the desired Th1 responses. IL-10 is a potential predictive biomarker of treatment outcome and increased cancer risk. The impact of HPV viral load requires further exploration to inform adjunct immunotherapies.
A HIGH PREVALENCE OF ANOGENITAL WARTS AND ANAL HPV INFECTIONS IN WOMEN WITH PRE-MALIGNANT CERVICAL LESIONS AT KING EDWARD HOSPITAL VII, DURBAN. (ID 1358)
Abstract
Introduction
The Human papillomavirus (HPV) is an established cause of anogenital warts, cervical precursor lesions, anal and cervical cancer. Women with cervical intraepithelial neoplasia (CIN) have an increased risk of anogenital warts and subclinical HPV infection in the anogenital compartment; however the prevalence of anal HPV infection in women with CIN remains unclear.
Methods
This was a prospective observational study of 148 women with high grade cervical intraepithelial neoplasia (HSIL) at King Edward VIII Hospital, Durban between October 2016 and March 2017. Clinical, behavioural and demographic data were collected with a structured questionnaire. A sub-set of 30 women over 30 years with no clinical evidence of anogenital warts were selected anal HPV testing. Dry anal mucosal swabs were collected to test for 37 HPV genotypes using the Roche Linear Array.
Results
The mean age of the study participants was 38 years, 97 % (n=145) were African black women, 94.6% (n=140) were HIV positive with a mean CD4 count of 481. The prevalence of anogenital warts was 16% (n=23); anogenital warts was associated with younger age (35 vs 38; p=0.0332), lower CD4 count (357 vs 477; p=0.0156) and presence of vaginal discharge (21.7% vs 9.6%; p=0.0467) respectively. Anal intercourse was not associated with anogenital warts 8.7% vs 9, 6% (p=0.4458). Anal HPV infection was 93.3% (n=28) with HPV 16 and 18 present in 64.3% (n=18). The average number of HPV sub-types per person was four [1; 10]; 25% (n=7) of women had three sub-types per person.
Conclusions
Anogenital warts and sub-clinical anal HPV infection are highly prevalent in women with high grade cervical intraepithelial neoplasia. Anal cytology or anoscopy should be considered in all women with cervical HSIL particularly in HIV positive women.