Abstract:

Background: Cancer of the cervix is the second most common cause of cancer related deaths among women in Sub – Saharan African, in some resource countries, it accounts for the highest rate of cancer mortality in women. It is estimated that 529,409 new cases are diagnosed annually with a mortality rate approaching 274,883 per year. Cervical intraepithelial neoplasia (CIN) precedes almost all cervical cancers. The incidence rate cervical intraepithelial Neoplasia (CIN) among HIV infected women is 4 to 5 times higher as compared to the rate in HIV negative women. The screening for cervical dysplasia and an appropriate management in women with CIN are effective in preventing cervical cancer.
Despite the fact that HIV infection and cervical cancer constitute a major reproductive health challenges in Bugando Medical Centre, no study has yet document the prevalence and predictors of CIN among HIV infected women. The purpose of this study was to determine the prevalence and predictors of CIN among HIV infected women attending Care and Treatment Centre (CTC) at Bugando Medical Centre.

Methods: A cross sectional survey undertaken among 355 HIV infected women aged from 18 years and above attending the BMC CTC clinic between February and March 2013. Visual Inspection with Acetic acid (VIA) was used as the screening method for detection of CIN. Socio-demographic, reproductive and clinical information was obtained from the eligible women; and blood was collected for a CD4 count check. Cervical punch biopsy for histological examination was performed for those who had VIA positive. Data were entered and analyzed using STATA version 12.0 software.

Results: A total number of 355 HIV infected women were recruited in the study. The prevalence of CIN was 58 (16%) in all HIV infected women who were enrolled in a study. 95 (26%) were VIA positive, and histology results showed 1(1.01%) had normal tissue, 3(3.16%) Atypia, Inflammatory lesions in 26 (27.4%), 31(32.6%) CIN 1, 27(28.4%) CIN2/3 and invasive cervical cancer 7(7.37%). The median baseline CD4 T lymphocyte count was 269 cells/mm3. The median CD4 T lymphocyte taken during study was 450cells/mm3. Predictors forcing were a history of multiple sexual partners (Adjusted OR 4.06; 95% CI 1.86 – 1.88 P<0.001), a history of genital warts (Adjusted OR 16.6; 95% CI 5.91 – 47.0 P<0,001), a history of STI (Adjusted OR 7.39; 95% CI 1.67 – 33.66, P = 0.010) and a low baseline CD4 T lymphocytes count of less than 200 cells/mm3 (Adjusted OR 2.71: 95% CI 1.24 – 5.90, P = 0.12).

Conclusion: The cervical Intraepitheal Neoplasm is major problem among HIV infected women. Results from this study emphasize the need for screening all HIV infected women for cervical cancer, using VIA. Although it is not specific and prone for over diagnosis, it is still an alternative screening method in resource limited settings.