A Study of Pap Smears in HIV-Positive and HIV-Negative Women from a Tertiary Care Center in South India

Abstract

Objectives: The aim of this work was to study the spectrum of epithelial abnormalities on Pap smears of HIV-positive women categorized as per the Bethesda System of Reporting Cervical Cytology, to correlate them with CD4 lymphocyte counts, and to compare them with the spectrum of abnormalities seen in a HIV-negative control group. Study Design and Methodology: The present study was a 6-year retrospective study conducted in the Department of Pathology at Kasturba Medical College, Mangalore, which included 150 Pap smears from HIV-positive and HIV-negative women, respectively. The Pap-stained slides of the cases were retrieved and studied. The data collected were tabulated and analyzed. A statistical study was performed using SPSS software. The χ² test was used to analyze the data and a p value < 0.05 was considered to be significant. Results: Pap smear abnormalities were twice as high in HIV-infected women (12%) as compared with HIV-negative women (6%; p = 0.006, RR = 2). Negative for intraepithelial lesion/malignancy was the most common finding (88%), which was further subdivided into inflammatory, atrophic smear, non-specific, candidiasis, and bacterial vaginitis groups. The percentage of epithelial abnormalities was 12%, including: atypical squamous cells of undetermined significance, 5.55%; atypical squamous cells, cannot exclude HSIL, 16.66%; low-grade squamous intraepithelial lesion, 5.55%; high-grade squamous intraepithelial lesion (HSIL), 61.11%, and squamous cell carcinoma, 11.11%. The highest incidence of intraepithelial lesions in HIV-positive females was in the age group of 34–49 years. CD4 cell counts fell in the range of 200–500 cells/mm³ in most of the HIV-positive patients (68.75%), but was not found to be statistically significant. Conclusion: Routine Pap smear examination is advocated in women with HIV as the prevalence of epithelial cell abnormalities was found to be 12%, which was twice as high as compared to the HIV-negative control group. Although there was no correlation of epithelial cell abnormalities with CD4 counts, a higher rate of the cases with epithelial abnormalities were observed to have CD4 cell counts of 200–500 cells/mm³.

Pattern and predictors of cervical epithelial cell abnormalities among unscreened and under-screened women in Lagos, Nigeria: a cross-sectional study

“…In Nigeria, the prevalence rate of CECA varies from 5%–11.3% in the northern region [ 29 , 30 ], 11.2%–16.5% in the eastern region [ 31 , 32 ] to 13.9%–34.6% in the western region [ 14 , 33 ]. Similar variation was observed in many LMICs with reported rates of 0.2%–12% in India [ 34 , 35 ], 2.5%–5.7% in Saudi Arabia [ 36 ], 3.7% in Ghana [ 37 ], 3.7% in Oman [ 38 ], 3.8% in Jordan [ 39 ], 4.4% in Kuwait [ 40 ], 5.1% in Turkey [ 41 ], 8.7% in Tanzania [ 42 ] and 14.1% in Ethiopia [ 43 ]. Several factors have been shown to account for this variation.…”

“…The odds of developing CECA were 26 times higher among HIV-positive women compared to those who are not. Other studies have also reported a higher prevalence among HIV-positive women compared to their counterparts [ 35 , 43 ]. This is not surprising as HIV/AIDS has been a major risk factor for the development of PCL and CCa due to its association with HPV and immunosuppressive state [ 35 , 37 , 42 , 44 ].…”

“…Other studies have also reported a higher prevalence among HIV-positive women compared to their counterparts [ 35 , 43 ]. This is not surprising as HIV/AIDS has been a major risk factor for the development of PCL and CCa due to its association with HPV and immunosuppressive state [ 35 , 37 , 42 , 44 ]. The level of CD4 count and stage of HIV/AIDS disease has also been shown to influence the development of PCL and CCa [ 42 , 43 ].…”

“…These include the rate of STI, HIV/acquired immune deficiency syndrome (AIDS), HPV infections and screening practices among women. Women with a high rate of these infections have an increased risk of CECA compared to others [ 35 , 43 , 44 ]. Similarly, women who had never been screened or who screen infrequently are at higher risk of having CECA.…”

“…They are usually a reflection of inflammatory, reactive or repair changes, but may also be due to HPV-related precancerous lesions [ 45 ]. Some studies have however reported LSIL [ 16 , 29 , 30 , 32 , 37 , 42 ] and HSIL [ 31 , 35 ] as the most commonly detected CECA during cytology. This is contrary to our findings where LSIL and HSIL were the least prevalent.…”