The Influence of HIV Infection on the Prevalence and Pattern of Cervical Cytological Abnormalities in Women in Lagos, Nigeria

Abstract

Background: Human immunodeficiency virus (HIV) has become a worldwide pandemic with over sixty percent of those infected in sub Saharan Africa. African women are disproportionately affected compared to their counterpart in other parts of the world. Cervical cancer is one of the leading causes of death in sub Saharan Africa including Nigeria. This study was carried out to determine the prevalence of cervical abnormalities, to determine the frequencies of various types of cervical abnormalities and the relationship between types of abnormal smears and CD4 count in HIV positive women, in Lagos, Nigeria. Methods: This is a cross sectional case control study of HIV positive patients attending the Lagos University Teaching Hospital HIV/AIDS clinic. The control group comprises patients undergoing routine Pap smear in LUTH and St. Kizito’s clinic, a missionary hospital in Lekki, Lagos. In all five hundred and ninety two women were included comprising 292 HIV positive women as case and 300 HIV negative women as control. Pap smear test and CD4 count were performed on the case group and HIV confirmation test on the control group. Results: The study found that there is a higher prevalence of squamous intraepithelial lesion among the HIV positive women compared with their HIV negative counter- part (20.2% vs 9.4%); also there is higher rate of human papillomavirus cytopathic effect among the HIV positive women (6.8% vs 3.7%). It was also observed that there is a decrease in abnormal smear pattern with high CD4 count (p<0.05). Conclusions: The study showed that there is a higher prevalence of abnormal cervical smears among the HIV positive women (HPW ) compared to the HIV negative women (HNW) and there is relationship between the CD4 count and abnormal cervical smear among the HPW. Pap smear should be incorporated into the management of HIV positive.