Browsing by Author "Ayeni, A. O."

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Human papillomavirus-based cervical precancer screening with visual inspection with acetic acid triage to achieve same-day treatments among women living with human immunodeficiency virus infection: test-of-concept study in Ibadan, Nigeria
(African Field Epidemiology Network (AFENET), 2021) Awolude, O. A.; Oyerinde, S. O.; Ayeni, A. O.; Adewole, I. F.
Introduction: cervical precancer screening with same day treatment facilitates maximization of benefits of secondary prevention of cervical cancer. This is particularly important for women living with human immunodeficiency virus (WLHIV) infection because of their exceptional risk for cervical cancer. The availability of HIV programmes in low- and middle-income countries (LMICs) provide unique opportunity for possible introduction “human papillomavirus (HPV) screening followed by visual inspection after application of acetic acid (VIA) with same day treatment of eligible patients”. This study piloted this concept. Methods: in this prospective, cohort study, 98 WLHIV had HPV and VIA screening for cervical precancer lesions in a HIV clinic in Nigeria. Participants positive to HPV and/or VIA had biopsies from the visible lesions or quadrant of transformation zone. Participants positive to VIA and/or HPV16 or HPV18/45 had same-day thermal ablation treatment and the number of cases documented. The HPV, VIA and scenario of HPV followed by VIA results were compared with histologically confirmed cervical lesion grade 2 or worse statistically. Results: same day treatment was achieved in 95.0% of eligible cases. Statistically, sensitivity and specificity of VIA was 25.0% and 50.0% and HPV had 95.5% and 75.0%, respectively. In the HPV screening with VIA triage, sensitivity dropped to 45.5% but specificity improved to 100.0%. Conclusion: triaging HPV positive test with VIA for same-day treatment in cervical precancer screening among PLWHIV looks feasible. The improved specificity will reduce the overtreatment rate, loss to follow-up associated with repeat clinic visits and improve completion of continuum of care.
Suspected Ovarian Malignancy in HIV Positive Woman Might Just be Abdominal Tuberculosis: Reports of Two Cases
(Society of Obstetrics & Gynaecology of Nigeria, 2020) Awolude, O. A.; Oyerinde, S. O.; Ayeni, A. O.
Abdominal extrapulmonary tuberculosis (EPTB) responds well to medical treatment. The cases present with features which may be non-specific simulating other diseases like ovarian cancers leading to unnecessary surgery. The EPTB is common among HIV-TB co-infected population. We report cases of abdominal EPTB among 2 HIV positive women mimicking cancer of ovary. Case one was a 41-year-old multiparous HIV positive woman with painless abdominal swelling of a month. Abdomen was distended with ascites and palpable abdominopelvic mass of about 14 weeks size confirmed as a right ovarian 9.8cm x 8.2cm mass on ultrasonography. Investigations showed marked lymphocytosis and CA-125 value of 1095 U/ml. Intraoperatively, there was widespread peritoneal and omental military nodules with adhesion of the colon with the uterus. Histology of specimen showed caseating granulomatous lesion with necrotizing inflammation and cytology of ascitic fluid showed admixture of neutrophil polymorphs, lymphocytes, and macrophages with no malignant cells. She had antituberculosis and responded satisfactorily to the treatment. The second case was a 50-year-old grand-multiparous with recurrent abdominal swelling one month after surgery for suspected ovarian cancer in a private hospital. The histology of surgical specimen did not show malignant cells. The abdomen was distended with ascites and firm irregular 12-14 weeks suprapubic mass confirmed from ultrasonography as a left adnexal complex mass. The Mantoux test and HIV screening were positive. She was treated with antituberculotic and antiretroviral drugs with satisfactory improvement. Conclusion: With the high prevalence of HIV-TB co-infection in our environment, the possibility of abdominal tuberculosis should be considered in HIV positive patients with abdominal mass. This diagnosis should be high in our differentials and use of ancillary investigations can be helpful in resolving this diagnosis to avoid unnecessary surgical interventions.