PREVALENCE OF ABNORMAL CERVICAL EPITHELIAL CYTOLOGY IN HIV SEROPOSITIVE WOMEN AND CORRELATION WITH CD4 COUNTS AND VIRAL LOAD IN UYO

Abstract

Background: Women in sub-Saharan Africa bear a disproportionate burden of HIV and HPV
infections. HPV is the pre-eminent etiologic agent of cervical cancer and its precursor lesions
while HIV is a risk factor. The interactions between HPV and HIV infections pose a great
challenge to public health especially where HIV prevalence is high and HPV vaccine coverage is
low. This is the case in Uyo, Akwa Ibom State.
Objective: This case-control, cross-sectional study was carried out to determine the prevalence
of cervical epithelial abnormalities in HIV-seropositive women in Uyo and correlating it with
their CD4 count and HIV viral load.
Methodology: Four hundred and sixty six consenting females comprising 231 HIV positive
women as cases and 235 HIV negative women as controls were recruited and screened for
cervical cancer and its precursor lesions using conventional Pap smear between February 2013
and April 2014. The cases were those attending the HIV clinic in UUTH while the controls were
women attending the Gynaecology, Family planning, and General Out-Patient clinics who tested
negative for HIV on VCT. Pap smears were collected and fixed in 95% Isopropyl alcohol and
then stained in the histopathology laboratory using standard Papanicolaou staining protocols. I
reviewed the slides with my supervising consultants. The slides were classified according to the
2001 Bethesda classification. HIV testing was done by two rapid tests (Determine and Unigold),
CD4 count was measured by flow cytometry, while the HIV viral load was determined by semi
automated conventional PCR within two weeks of Pap smear screening.
Result: The samples of 449 women comprising 226 HPW and 223 HNW were suitable for
statistical analysis. The study participants were aged between 18-60 years with a mean age of
35.24±9.26 years and 35.63±8.44 years in the control- and case- participants respectively.
Majority of the study participants were between the ages of 25 years and 36 years. The mean
CD4 count and the mean HIV viral load in the case-participants were 311.08±299.1 cells/mm3
(range 6-1779) and 354449.51±1257979.9/microliter (range <400-9,623,070) respectively.
95.1% of the HNW and 89.3% of the HPW were negative for Squamous Intraepithelial Lesions
(SILs). The prevalence of abnormal cervical cytology was more than two times higher in the
cases than in the controls (10.6% vs 4.9%, p<0.05). The frequency for all categories of SILs was
higher in the HPW. HPW with a higher viral load had the lowest mean CD4 count and the worst
cytologic abnormality. Women on longer duration of HAART treatment also had a higher mean
CD4 count and better cytologic result. 10.9% of the HPW and 5.7% of the HNW with a negative
cytology report had inflammatory smears.
Conclusion: This result adds to epidemiological data and supports the inclusion of cervical
cancer screening in the routine care of women living with HIV/AIDS in this region so as to
reduce the burden of cervical neoplasia. This is important so that the benefit of HAART
treatment will not be offset by excess burden of cervical cancer in this group of patients.