Volume 5 Supplement 1

Proceedings of the 12-th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI)

Open Access

A higher proportion of squamous intraepithelial lesion of the cervix in symptomatic HIV-infected women at a tertiary health center in Tanzania

  • Joseph Obure1, 2Email author,
  • Pendo Mlay1,
  • Gileard Masenga1,
  • Olola Oneko1 and
  • David Walmer2
Infectious Agents and Cancer20105(Suppl 1):A1

DOI: 10.1186/1750-9378-5-S1-A1

Published: 11 October 2010

Background

Many study reports have associated cervical squamous intraepithelial lesion (SIL) and HIV infection [1,2]. In Tanzania, however, there are limited and conflicting published reports on the association between HIV infection and SIL [3]. A study was conducted to determine the proportion and severity of SIL in HIV-infected women attending a cervical cancer screening clinic at Kilimanjaro Christian Medical Center (KCMC) in Tanzania. A total of 214 women 18 to 60 years old, among whom 99 (46.3%) and 115 (53.7%) were HIV-seropositive and HIV-seronegative, respectively, were recruited in the study. Blood samples were taken to associate SIL and degree of HIV infection by CD4+ T lymphocyte counts. Structured questionnaires with socio-demographic characteristics were administered while cervical smears were taken from all women to determine and grade the degree of SIL. High-grade and low-grade squamous intraepithelial lesions were regarded as abnormal smear. Overall proportion of SIL was 17%. Proportion of SIL among HIV-seropositive subjects was 32% versus 4% in seronegative subjects (OR=13.3, 95% CI=4.2-46.4) (see Table 1). Low CD4+ T lymphocyte cell count was associated with higher proportion of SIL (p=0.001) (see Table 2). The relationship between CD4+ T lymphocyte cell counts and the severity of cervical SIL was significant (p=0.007) (see Table 3). Marital status and number of lifetime sex partners were risk factors significantly associated with SIL (p=0.004 and 0.005, respectively). There was no association between SIL with age, education level, parity, or age at sex debut.
Table 1

Relationship between HIV serostatus and cervical SIL (n, 214).

Variable

Total

Pap results

Chi-square

p-value

OR (95% CI)

  

SIL

Normal

   
  

No (%)

No (%)

   

HIV-seropositive

99

32 (32.3)

67 (67.7)

   

HIV-seronegative

115

4 (3.5)

111 (96.5)

31.5

<0.001

13.3 (4.2-46.4)

Note; Pap = Papanicolous smear; SIL = Squamous Intraepithelial Lesion.

Table 2

Relationship between SIL and HIV disease progression according to CD4+ T lymphocyte count (cells/microL).

Variable

Total

PAP smear results

Chi-square

p-value

  

SIL

Normal

  
  

No. (%)

No. (%)

  

CD4+ T lymphocyte cell Count (cells/microliter):

     

Less than 200

31

18 (58.1)

13 (41.9)

  

200-499

49

32 (32.3)

38 (77.6)

  

500 or more

19

4 (3.5)

16 (96.5)

13.9

0.001

Note: PAP = Papanicolous; SIL = Squamous Intraepithelial Neoplasia.

Table 3

Relationship between degree of SIL and degree of HIV progression (n=99).

Variable

Total

PAP smear results

Chi-square

p-value

  

HGL

LGL

Normal

  
  

No. (%)

No. (%)

No. (%)

  

CD4+ T lymphocyte cell Count (cells/microliter):

      

Less than 200

31

7 (22.6)

11(35.5)

13 (14.9)

  

200-499

49

4 (8.2)

7 (14.3)

38 (77.6)

  

500 or more

19

1 (5.3)

2 (10.5)

16 (84.2)

14.0

0.007

Note: PAP = Papanicolous; HGL = High-Grade Squamous Intraepithelial Lesion; LGL = Low-Grade Squamous Intraepithelial Lesion.

Conclusion

SIL diagnosis was significantly associated with HIV infection with inverse relationship between HIV disease progression and degree of SIL. These findings underscore the need for HIV screening among women with SIL, and the need for cervical cancer screening in HIV-infected women. Marital status and number of lifetime sex partners were significant risk factors associated with SIL.

Declarations

Acknowledgements

This article has been published as part of Infectious Agents and Cancer Volume 5 Supplement 1, 2010: Proceedings of the 12th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI).The full contents of the supplement are available online at http://www.biomedcentral.com/1750-9378/5?issue=S1.

Authors’ Affiliations

(1)
Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical CenterMoshi
(2)
Departments of Obstetrics and Gynecology, Duke University Medical Center

Copyright

© Obure et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.

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