Sero-prevalence of HIV among patients with cervical cancer managed at the Tikur Anbassa Hospital Addis Ababa, Ethiopia

Abstract

Background: Cervical cancer is the second most common cancer among women in the world. Globally, according to the 2010 report, 493,243 women diagnosed with cervical cancer and 273, 505 of them died from the disease. It is also the commonest gynecologic cancer in the Ethiopian women. Ethiopia is one of the Sub- Saharan African countries with high HIV prevalence. Studies done in different parts of the world demonstrated clear association between HIV and premalignant cervical lesions but studies on HIV prevalence in invasive cervical cancer are few and showed a wide range of variations.

Objective: To determine the sero-prevalence of HIV among patients with histologically confirmed cervical cancer in Addis Ababa, Ethiopia. Design: A facility based cross-sectional descriptive study. Setting: Tikur Anbassa hospital, Addis Ababa, the only comprehensive cancer treatment center in Ethiopia. Main variables: Prevalence of HIV, mean age, diagnosis of cervical cancer.

Materials and methods: All newly diagnosed, and biopsy proven uterine cervical cancer patients who were managed at Tikur Anbassa hospital records were sought. The records were identified perused and those found to fulfil study entry criteria were evaluated and information collected using structured questionnaire. Data required from each study subject included; socio-demographic, reproductive characteristics and clinical information. Data was then pooled, screened and entered in SPSS. The results were computed and presented in the form of; tables and figures, mean with standard deviation and proportion for quantitative and qualitative statistic respectively. T-test for equality, Chi-square test, and logistic regression were used to measure associations. Significance level was set at P value of 0.05.

Result: Of the 255 subjects studied, majority has late clinical stage and squamous cell carcinoma histologically, 64.7% and 92.5% respectively. Similarly,34 out of the 255 were positive for HIV, making the overall sero-prevalence rate of 13.3%. The mean age of the total study population was 46 ±10.55 years. Significant difference was observed in the mean age of cervical cancer occurrence for HIV infected cases compared to the non-infected, 37.01 ± 6.7 and 48.23±10.26 years, respectively (p=000). HIV status and CD4 count were not shown to have any association with clinical stage and histologic variants. Having more than one lifetime sex partner and age less than 40 years were independently shown to have significant association with HIV sero-positivity. Mean CD4 count of the HIV positive subjects was 442.2±251.27.

Conclusion and recommendation: In this study HIV infected women with cervical cancer were 8 to 14 years younger than HIV- negative women with cervical cancer. The disease stage and histology were not different in both groups, and without evidence of advanced disease in immune compromised state. It is recommending that further larger scale multicenter study, to explore the reasons for the younger age of occurrence of invasive cervical cancer in patients with HIV/AIDS.