Cervical Cancer Screening among Human Immunodeficiency Virus-positive Women: A Comparison of Outcome between Visual Inspection with Acetic Acid and Papanicolaou Smear Cytology.

IF 1 Q3 MEDICINE, GENERAL & INTERNAL

Annals of African Medicine Pub Date : 2026-04-17 DOI:10.4103/aam.aam_71_26

Chidiebere Okechukwu Ifebi, Chibuike Ogwuegbu Chigbu, Leonard Ogbonna Ajah, Uzochukwu U Aniebue, Emeka Francis Nnakenyi, Monique Iheoma Ajah

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Abstract

Background: Cervical cancer is the most common gynecological cancer in sub-Saharan Africa. Human immunodeficiency virus (HIV) infection is associated with cervical epithelial cell abnormalities. Cervical cancer screening in Nigeria is very low, and the available screening modalities have varying barriers and overall accuracies.

Objectives: The objective is to compare the accuracy of papanicolaou (Pap) smear cytology and visual inspection with acetic acid (VIA) among HIV-positive women in Enugu, South-East Nigeria.

Methodology: This was a cross-sectional comparative study of 438 HIV-infected women who attended the adult antiretroviral therapy clinic at University of Nigeria Teaching Hospital, Enugu, from January 2 to June 30, 2019. The eligible participants underwent Pap smear cytology, VIA, and Colposcopy. Punch biopsy was performed at the lesions (if any), 2, 6, 10, and 12 o'clock positions of the cervix. Histology of the biopsy specimens was used as the gold standard.

Results: Approximately 21.2%, 24.7%, and 18.7% of the participants had abnormal colposcopy and biopsy results, acetowhite reaction on VIA, and abnormal Pap smear cytology results, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of Pap smear cytology were 59.2% (48.0%-69.6%), 89.8% (86.2%-92.5%),54.9% (44.1%-65.2%), 91.3% (87.9%-93.8%), and 84.5% (80.8%-87.6%), respectively. Furthermore, the sensitivity, specificity, PPV, NPV, and overall accuracy of VIA were 64.5% (53.2%-74.3%), 83.7% (79.5%-87.2%), 45.3% (36.3-54.8%), 91.9% (88.3%-94.4%), and 80.4% (76.4%-83.8%), respectively. There was no statistical significant difference between Pap smear cytology and VIA in overall accuracy (P = 0.11).

Conclusion: There was a high prevalence of cervical epithelial cell abnormalities among HIV-positive women in Enugu. The overall accuracy of Pap smear cytology was essentially similar to that of VIA in screening for cervical epithelial lesions. Therefore, VIA is a cheaper, more affordable, and more readily available alternative to Pap smear cytology, especially in Nigeria.

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人类免疫缺陷病毒阳性妇女宫颈癌筛查：醋酸目视检查与巴氏涂片细胞学结果的比较

背景：宫颈癌是撒哈拉以南非洲地区最常见的妇科癌症。人类免疫缺陷病毒（HIV）感染与宫颈上皮细胞异常有关。尼日利亚的宫颈癌筛查率非常低，现有的筛查方式存在不同的障碍和总体准确性。目的：目的是比较巴氏涂片细胞学（Pap）和醋酸目视检查（VIA）在尼日利亚东南部埃努古艾滋病毒阳性妇女中的准确性。方法：这是一项横断面比较研究，对2019年1月2日至6月30日在埃努古尼日利亚大学教学医院成人抗逆转录病毒治疗诊所就诊的438名艾滋病毒感染妇女进行了研究。符合条件的参与者接受了巴氏涂片细胞学、VIA和阴道镜检查。在宫颈病变（如果有）、2、6、10和12点钟位置进行穿孔活检。活检标本的组织学作为金标准。结果：大约21.2%、24.7%和18.7%的参与者分别有阴道镜和活检结果异常、VIA乙酰白反应和巴氏涂片细胞学结果异常。巴氏涂片细胞学的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和总体准确性分别为59.2%（48.0% ~ 69.6%）、89.8%（86.2% ~ 92.5%）、54.9%（44.1% ~ 65.2%）、91.3%（87.9% ~ 93.8%）和84.5%（80.8% ~ 87.6%）。VIA的敏感性为64.5%(53.2% ~ 74.3%)，特异性为83.7% (79.5% ~ 87.2%)，PPV、NPV和总体准确率分别为45.3%（36.3 ~ 54.8%）、91.9%（88.3% ~ 94.4%）和80.4%（76.4% ~ 83.8%）。巴氏涂片细胞学与VIA在总体准确性上无统计学差异（P = 0.11）。结论：埃努古地区hiv阳性妇女宫颈上皮细胞异常发生率高。巴氏涂片细胞学在筛查宫颈上皮病变方面的总体准确性与VIA基本相似。因此，与巴氏涂片细胞学相比，VIA是一种更便宜、更实惠、更容易获得的替代方法，尤其是在尼日利亚。

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来源期刊

Annals of African Medicine MEDICINE, GENERAL & INTERNAL-

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0.90

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期刊介绍： The Annals of African Medicine is published by the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria and the Annals of African Medicine Society. The Journal is intended to serve as a medium for the publication of research findings in the broad field of Medicine in Africa and other developing countries, and elsewhere which have relevance to Africa. It will serve as a source of information on the state of the art of Medicine in Africa, for continuing education for doctors in Africa and other developing countries, and also for the publication of meetings and conferences. The journal will publish articles I any field of Medicine and other fields which have relevance or implications for Medicine.