Prevalence and predictors of Pap smear cervical epithelial cell abnormality among HIV-positive and negative women attending gynecological examination in cervical cancer screening center at Debre Markos referral hospital, East Gojjam, Northwest Ethiopia

Abstract

BackgroundCervical cancer is the leading cause of cancer related death among women in developing countries. Cervical cancer is preceded by cervical surface epithelial cell abnormalities (ECA) which can be detected by Pap smear test. Simultaneous human papillomavirus and human immunodeficiency virus (HIV) infection increases cervical cancer. Data on the prevalence and predictors of ECA among women in Ethiopia is limited. Hence, we aimed to determine the prevalence and associated factors of ECA among women.MethodsA comparative cross-sectional study was conducted among HIV+ and HIV- women attending gynecological examination in cervical cancer screening center at the Debre Markos referral hospital. The study subjects were stratified by HIV status and systematic random sampling method was used to recruit study participants. Cervical smears were collected for Pap smear examination. Logistic regression analysis was employed to examine the possible risk factors of cervical ECA.ResultsA total of 197 HIV+ and 194 HIV- women were enrolled in the study. The overall prevalence of cervical ECA was 14.1 % of which the prevalence of atypical squamous cells undetermined significance (ASCUS), low grade squamous intraepithelial lesion (SIL), high grade SIL, squamous cell carcinoma and ASC, cannot exclude high grade SIL (ASCH) were 5.1, 3.8, 4.1 and 1.0 %, 0.0 % respectively. Significantly higher prevalence of ECA (17.8 %) was observed among HIV+ women (COR 1.9, 95 % CI: 1.1 − 3.4, p = 0.036) as compared to HIV-women (10.3 %). Multiple sexual partnership (AOR 3.2, 95 % CI: 1.1 − 10.0, p = 0.04), early ages of first sexual contact (<15 years) (AOR 5.2, 95 % CI: 1.5 − 17.9, p = 0.009), parity greater than three (AOR 10.9, 95 % CI: 4.2 − 16.8, p < 0.001) and long term oral contraceptive pills (OCP) use (AOR 11.9, 95 % CI: 2.1 − 16.7, p = 0.02) were significant predictors of prevalence of ECA.ConclusionsCervical ECA is a major problem among HIV-infected women. Lower CD4+ T-cell counts of below 350 cells/μl, HIV infection, multiple sexual partnership, early age at first sexual contact, parity greater than three and long term OCP use were significant predictors of prevalence of ECA. Strengthening screening program in HIV+ women should be considered.

Cervical Cytology or Colposcopy in the Identification of Cervical Intraepithelial Neoplastic Changes in Human Immunodeficiency Virus Positive Patients in an African Population?

“…This was comparable to a study conducted in Cameroun which reported a prevalence of 43.5% [20], further giving credence to the fact that CIN changes are more in patients with HIV infection. Other studies conducted in Nigeria and Ethiopia, however, showed lower prevalence rates [21,22]. The difference in the prevalence rates may be due to the use of cytological smears for the diagnosis of CIN as opposed to histologically confirmed lesions used in this study.…”

Precursor lesions of cervical cancer in HIV-positive women and their relationship with CD4+ and viral load Gaffrée and Guinle University Hospital

“…Getinet et al (17) encontraram na Etiópia, em 197 pacientes HIV positivo, 82,2% de amostras negativas, 5,6% de ASCUS, 6,1% de LSIL, 5,1% de HSIL e 1,0% de carcinoma escamoso. Kreitchmann et al, (18) em Porto Alegre, encontraram amostras negativas em 82,5%, ASCUS em 6,2%, LSIL em 8,7%, HSIL em 2,4% e carcinoma invasor em 0,1%, valores semelhantes aos encontrados em nosso estudo, apenas com a diferença de terem encontrado carcinoma epidermoide.…”

“…Em nosso estudo, os resultados encontrados foram semelhantes aos encontrados por Getinet et al, (17) Chalermchockcharoenkit et al, (16) Silva et al, (13) Kreitchmann et al, (16) Brock (17) e Lemos et al (18) Apenas Camargo et al (21) obtiveram índices inferiores de positividade, com maior índice de LSIL e ASCUS em relação aos demais.…”

“…Apenas Getinet et al (17) e Kreitchmann et al (16) encontraram resultados de carcinoma escamoso invasor, diferente do encontrado no nosso estudo.…”

A study of CD4 count and cervical epithelial abnormality in HIV positive women

“…Cervical epithelial cell abnormalities (ECA) can result in cervical cancer which is the most common cause of cancer related death especially in developing countries [2]. Cervical ECA can be detected by Pap smear.…”