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Cervical intraepithelial neoplasia (CIN) in African women living with HIV: role and effect of rigorous histopathological review by a panel of pathologists in the HARP study endpoint determination
  1. Sylviane Doutre1,
  2. Tanvier Omar2,
  3. Olga Goumbri-Lompo3,
  4. Helen Kelly4,
  5. Omar Clavero5,
  6. Souleymane Zan6,
  7. Admire Chikandiwa7,
  8. Bernard Sawadogo8,
  9. Sinead Delany-Moretlwe7,
  10. Valérie Costes1,9,
  11. Philippe Mayaud4,7,
  12. Michel Segondy1,9
  13. on behalf of the HARP Study Group
  1. 1 Department of Biology and Pathology, University Hospital (CHU), Montpellier, France
  2. 2 Department of Pathology, National Health Laboratory Services Johannesburg, South Africa
  3. 3 Department of Pathology, University Teaching Hospital Yalgado, Ouagadougou, Burkina Faso
  4. 4 Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
  5. 5 Department of Pathology, Catalan Institute of Oncology, Barcelona, Spain
  6. 6 Department of Gynaecology, University Teaching Hospital Yalgado, Ouagadougou, Burkina Faso
  7. 7 Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
  8. 8 Centre de Recherches Internationales en Santé (CRIS), University of Ouagadougou, Burkina Faso
  9. 9 Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, Montpellier, France
  1. Correspondence to Prof. Michel Segondy, Department of Biology and Pathology, Laboratory of Virology, St-Eloi Hospital, 34295 Montpellier Cedex 05; m-segondy{at}


AIMS To analyse the effect of the expert end-point committee (EPC) review on histological endpoint classification of cervical intraepithelial neoplasia (CIN).

Methods A cohort of women living with HIV were recruited in Burkina Faso (BF) and South Africa (SA) and followed over 18 months. Four-quadrant cervical biopsies were obtained in women with abnormalities detected by at least one screening test. A central review by a panel of five pathologists was organised at baseline and at endline.

Results At baseline the prevalence of high-grade CIN (CIN2+) was 5.1% (28/554) in BF and 23.3% (134/574) in SA by local diagnosis, and 5.8% (32/554) in BF and 22.5% (129/574) in SA by the EPC. At endline the prevalence of CIN2+ was 2.3% (11/483) in BF and 9.4% (47/501) in SA by local diagnosis, and 1.4% (7/483) in BF and 10.2% (51/501) in SA by EPC. The prevalence of borderline CIN1/2 cases was 2.8% (32/1128) and 0.8% (8/984) at baseline and endline. Overall agreement between local diagnosis and final diagnosis for distinguishing CIN2+ from ≤CIN1 was 91.2% (κ=0.82) and 88.9% (κ=0.71) for BF at baseline and endline, and 92.7% (κ=0.79) and 98.7% (κ=0.97) for SA at baseline and endline. Among the CIN1/2 cases, 12 (37.5%) were graded up to CIN2 and 20 (62.5%) were graded down to CIN1 at baseline, and 3 (37.5%) were graded up to CIN2 and 5 (62.5%) were graded down to CIN1 at endline.

Conclusions This study highlights the importance of a centralised rigorous re-reading with exchange of experiences among pathologists from different settings.

  • cervical cancer
  • histopathology
  • HIV

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  • Handling editor Tahir S Pillay.

  • Contributors PM, HK and MS conceived and planned the study. SD, TO, OG-L, OC and VC constituted the EPC and discussed the results. SD was involved in quality assessment. SZ performed colposcopic diagnosis. BS supervised the study in Burkina Faso and AC and SDM supervised the study in South Africa. HK and PM recorded and analysed the data. PM, HK and MS wrote the manuscript. All authors read and approved the final manuscript.

  • Funding The research leading to these results has received funding from the European Commission (EC) 7th Framework Programme under grant agreement No. HEALTH-2010-F2-265396.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was obtained from the Ministry of Health of Burkina Faso, University of Witwatersrand in Johannesburg and London School of Hygiene & Tropical Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Collaborators Other contributing members of the HARP study group included: E Cutler, DA Lewis, MP Magooa, V Maseko, P Michelow, B Muzah, T Omar, A Puren (Johannesburg, SA); F Djigma, J Drabo, N Meda, J Simporé, A Yonli (Ouagadougou, BF); MN Didelot, N Leventoux, N Nagot, J Ngou (Montpellier, France); and A Devine, C Gilham, L Gibson, R Legood, HA Weiss (London, UK).