Association between HIV serostatus and premalignant cervical lesions among women attending a cervical cancer screening clinic at a tertiary care facility in southwestern Uganda: a comparative cross-sectional study

Abstract

Background: Uganda has approximately 1.2 million people aged 15–64 years living with human immunodeficiency virus (HIV). Previous studies have shown a higher prevalence of premalignant cervical lesions among HIV-positive women than among HIV-negative women. Additionally, HIV-infected womenare more likely to have their human papilloma virus (HPV) infection progress to cancer than non-HIV-infected women. We determined the prevalence of premalignant cervical lesions and their association with HIV infection among women attending a cervical cancer screening clinic at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. Methods: We conducted a comparative cross-sectional study of 210 women aged 22–65 years living with HIV and 210 women not living with HIV who were systematically enrolled from March 2022 to May 2022. Participants were subjected to a structured interviewer-administered questionnaire to obtain their demographic and clinical data. Additionally, Papanicolaou smears were taken for microscopy to observe premalignant cervical lesions. Multivariable logistic regression was performed to determine theassociation between HIV status and premalignant cervical lesions. Results: The overall prevalence of premalignant cervical lesions in the study population was 17% (n=72; 95% C.I: 14.1-21.4), with 23% (n=47; 95% C.I: 17.8-29.5) in women living with HIV and 12% (n=25; 95% C.I: 8.2-17.1) in women not living with HIV (p<0.003). The most common premalignant cervical lesions identified were low-grade squamous intraepithelial lesions (LSIL) in both women living with HIV (74.5%; n=35) and women not living with HIV (80%; n=20). HIV infection was significantly associated with premalignant lesions (aOR: 2.37, 95% CI: 1.27–4.42,p=0.007). Conclusion: Premalignant cervical lesions, particularly LSILs, were more common in HIV-positive women than in HIV-negative women, highlighting the need to strengthen the integration of cervical cancer prevention strategies into HIV care programs.

The association between HIV infection and precancerous cervical lesion. A systematic review and meta‐analysis of case–control studies

“…For instance, studies conducted in Ruanda and Ethiopia revealed that HIV-infected women have a higher risk of precancerous cervical lesion. 14,15 Conversely, these reports are argued by the findings of other researchers. 16,17 Besides to the variability in the presence of a significant association between HIV infection and precancerous cervical lesion, the strengths of the reported measures of association are also different across studies that report significant associations.…”

“…However, the findings are not consistent throughout the studies. For instance, studies conducted in Ruanda and Ethiopia revealed that HIV‐infected women have a higher risk of precancerous cervical lesion 14,15 . Conversely, these reports are argued by the findings of other researchers 16,17 …”