2024/07/22 by Ugboaja, Joseph Odirichukwu, Ubajaka, Chika Florence, Oranu, Emmanuel Okwudili +4
#Developing countries #HIV infection #gynecological malignancies #screening
paper · doi:10.60787/njgp.v17i2.34
Background: HIV infection is associated with increased risk of precancerous and cancerous lesions of the cervix. There is a need to identify the women mostly at risk to guide cervical cancer screening efforts. The objective of this study was to evaluate the determining factors for premalignant lesions of the cervix among HIV-positive women attending the adult HIV clinic in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. Materials and Methods: The Pap smears of 110 HIV-positive women were selected through purposive sampling and evaluated for premalignant lesions of the cervix using the Bethesda system of classification. STATA software, version 12.0 SE (Stata Corporation, TX, USA; 1985), was used to analyze the data, and multiple logistic regression models were employed to determine the risk factors of premalignant lesions. P = 0.05 at 95% confidence interval was taken as statistically significant. Results: The prevalence of premalignant lesions of the cervix was 28.2%, and these constitute mainly of atypical squamous cells of undetermined significance (56.5%). Women with cervical cytological abnormalities have significantly lower mean age (35.39 vs. 38.89; P = 0.04), lower mean CD4 count (325.3 vs. 648; P < 0.01), and lower mean age of coitarche (15.89 vs. 19.9; P < 0.001). On bivariate analysis, the significant determinants of abnormal cervical cytology include CD4 count <300 cells/mm3 (odds ratio [OR] = 0.037; P < 0.001), age <30 years (OR = 0.26; P < 0.01), duration of illness of <5 years (OR = 0.34; P < 0.05), and the use of highly active antiretroviral therapy (HAART) for <5 years (OR = 0.09;P < 0.001). On multivariate analysis, CD4 count <300 cells/mm3 (adjusted OR [aOR] = 0.018; P < 0.001) and the use of HAART for <5 years (aOR = 0.13; P < 0.05) significantly predicted the presence of premalignant lesions. Conclusion: The determinants of cervical cytological abnormalities among the women were CD4 count <300 cells/mm3 and the use of HAART for <5 years. We recommend routine screening for cervical cancer among this class of women.