Comparison of papanicolaou smear tests among HIV negative and HIV positive pregnant Women on HAART at a tertiary hospital

Abstract

Background: Cervical cancer is the most common gynaecological cancer worldwide, causing morbidity and mortality, especially in
developing countries like Nigeria. It develops from premalignant lesions of the cervix. Human immune deficiency virus (HIV) increases the risk of dysplastic changes in the cervix. Pregnant HIV-positive women may be at a higher risk of having pre-invasive cervical lesions. Pregnancy presents an opportunity to screen women for premalignant lesions of the cervix using a Papanicolaou (Pap) smear, especially in an environment like ours where women of reproductive age have poor health-seeking behaviour. The objective of this study is to compare the cytological patterns of Pap smear of pregnant women who are HIV positive compared to their HIV negative counterparts at the antenatal clinic of Alex Ekwueme Federal University Teaching Hospital Abakaliki (AE-FUTHA).
Methodology: This is a comparative cross-sectional study that involved performing Pap smears on consenting HIV-positive pregnant
women on HAART and HIV-negative pregnant women attending the antenatal clinic of AE-FUTHA. One hundred pregnant HIV-positive
women on HAART and one hundred pregnant HIV-negative women who met the inclusion criteria and gave consent were recruited into the study by consecutive sampling method. A pretested questionnaire was administered to the women. A pap smear test was carried out on each of the participants. The data was analysed using Epi info version 7.2.1. Continuous variables were presented as mean and standard deviation while categorical variables were presented as numbers and percentages. Categorical variables were analysed using Chi-square (Fisher’s exact test was also used), while means were compared using a t-test. A P-value ˂ 0.05 was considered as statistically significant.
Result: The prevalence of abnormal Pap smear among pregnant women in AEFUTHA was 14%. The prevalence among HIV-positive
pregnant women was 24% while the prevalence for HIV-negative women was 4%. This difference was statistically significant (P value was <0.001).
Conclusion: This study has demonstrated the presence of premalignant cervical lesions in pregnant women with a significantly higher
prevalence among HIV-positive pregnant women. Therefore, there is a need to incorporate Pap smear tests among routine antenatal
investigations, especially for HIV-positive pregnant women.