High-risk human papillomavirus among HIV-infected women with normal cervical cytology: a pilot study in Jos, Nigeria.

BACKGROUND: Cervical cancer is strongly linked to high-risk human papillomavirus (HR-HPV) and is typically preceded by cytological abnormalities. Less is known in patients with normal cervical cytology (NCC). We investigated the epidemiology of HR-HPV among HIV-infected women with NCC. METHODOLOGY: We conducted a cross-sectional study between January and June 2011 among HIV-infected women with NCC at an adult HIV clinic in Jos, Nigeria. Cervical sampling and analysis for HR-HPV by hybrid capture (HC2) with signal amplification was done to determine presence of one or more of the following HR-HPV types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 or 68. Epidemiologic factors associated with HR-HPV were determined using bivariate statistics and multivariate logistic regression. RESULTS: We evaluated 103 HIV-infected women with Pap cytology. The median age of the women was 32 years (range 21-49). Ninety-seven (94.2%) had NCC. Cervical samples for HR-HPV DNA testing were available from 89/97 (91.8%) of the HIV-infected women with NCC. Of the 89 women with cervical samples for HR-HPV DNA testing, 40 (44.9%) had detectable HR-HPV by HC2 giving a HR-HPV prevalence of 44.9% (95% CI 33.9-55.5%). Age < 30 years was associated with HR-HPV (OR 2.69 [95% CI 1.05-6.91, p = 0.039]) while history of previous abortion showed an inverse association with HR-HPV (OR 0.33[95% CI 0.15-0.94, p = 0.039]). CONCLUSION: The prevalence of HR-HPV is seemingly high among HIV-infected women with NCC in our clinical setting. These data provide support for further investigation of the clinical implications of positive HR-HPV among HIV-infected women with NCC report in cervical cancer prevention programs in Nigeria.

The challenges of managing malignant head and neck tumors in a tropical tertiary health center in Nigeria.

INTRODUCTION: In developing countries, factors such as late patient presentation, inaccessible and limited health facilities contribute to the poor outcome in the management of patients with head and neck malignant tumors. This study presents the challenges faced by the otorhinolaryngologist in our environment in the management of patients with head and neck malignant tumors. METHODS: This is a ten-year retrospective chart review of patients with histopathologically confirmed head and neck malignancies in the Jos University Teaching Hospital, Jos, Nigeria. RESULTS: Eighty nine patients, with male predominance (gender ratio of 2.7:1) aged between 23 and 78 years had head and neck malignancies. Eighty eight (99%) patients had histopathological diagnosis. Most patients were from rural areas and had seen the herbalist prior to presentation. Thirty four (38.2%) patients were in the 4th decade of life. Eighteen (20.2%) patients presented within 6 months of onset of illness and 71 (79.8%) patients after 6 months with 38/89 patients having cervical lymphadenopathy at presentation. Four (4.5%) patients were able to afford CT scan. Twenty eight deaths were recorded. Ten patients were lost to follow-up. CONCLUSION: The challenges faced in managing patients with head and neck malignant tumors in our environment are enormous but surmountable. Therefore urgent efforts should be made by health workers and government to ensure a better outcome for these patients.