About 31 million adults and children are estimated to have been infected with HIV worldwide, and about 21 million (68%) of all infections are assumed to be in sub-Saharan Africa. It is also estimated that 80% of all female HIV infections worldwide are in sub-Saharan Africa. In Malawi, the prevalence of HIV is 30% among pregnant women and the incidence of HIV is about 4 per 100 person-years among women of reproductive age. The rates of other sexually transmitted diseases (STDs) are also high; e.g.,the prevalence of syphilis is 11%, Trichomoniasis is 24%, genital ulcers is 3.4%, and genital warts is 2.5%. There is increasing evidence linking human papilloma virus (HPV) with cervical intraepithelial neoplasia (CIN) and carcinoma. These conditions were also reported to be more frequent among HIV infected women. Earlier studies by our research team in Malawi have shown that squamous intraepithelial lesions were present in 15% (17/116) of HIV-infected and 7% (11/152) of HIV-uninfected women (p=0.05), and in 23% (19/83) of HPV polymerase chain reaction (PCR) positive and 4% (6/156) of HPV PCR negative women (p<0.001). Beyond this limited data, the prevalence of cervical abnormalities among Malawian women is not known. Efforts to develop a registry could not be sustained. Among the major problems are lack of trained personnel and the laboratory infrastructure. At present, there is only one histopathologist and one cytologist in the entire country. Therefore, training and strengthening of the local capabilities are urgently needed. The purpose of this proposed supplemental funding is to provide technical and laboratory training in fields of HIV related malignancies such as cervical cancer. Training in epidemiology (including cancer surveillance), laboratory techniques (including cytology and HPV diagnostics) and clinical diagnosis and management will be a priority. Training will be accomplished through several mechanisms at Johns Hopkins University, in-country workshops, and regional centers with appropriate experience.
| Sahasrabuddhe, Vikrant V; Vermund, Sten H (2007) The future of HIV prevention: control of sexually transmitted infections and circumcision interventions. Infect Dis Clin North Am 21:241-57, xi |
