Screening of HIV sero positive women for cervical abnormalities
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20183321Keywords:
HIV, Pap smears screening, Squamous intraepithelial lesionAbstract
Background: Cancer cervix is a leading cause of death among women worldwide. Detection of cervical cancer in precancerous stage is 100% curable. Screening with Pap smear has reduced mortality by cervical cancer in developed countries many folds. The objective of the study is to determine prevalence of Cervical Intraepithelial Neoplasia (CIN) in HIV infected women and observe for associated lower genital infections and their correlation with CD4 counts.
Methods: The present study is a cross-sectional observational study conducted at PGIMS, Rohtak, Haryana for a period of 18 months. 150 HIV patients and 150 age related control cases were taken. Pap smears were taken and analyzed for cervical abnormalities and genital infections.
Results: Of the 300 Pap smear 22 (7.3%) has squamous intraepithelial abnormalities and 278 (92.7%) negative for intra epithelial abnormalities. Prevalence of cervical intraepithelial abnormities among HIV positive 12% while among HIV negative it is 2.7%. Cervical intraepithelial abnormalities were found in 40% and 3.5% of patients with CD4 count <200 and >200 respectively.
Conclusions: HIV increases the risk of cervical abnormalities. Frequent screening of these patients for cervical cancer is needed.
References
Sankaranarayanan R, Budukh AM, Rajkumar R. Effective screening programmes for cervical cancer in low-and middle-income developing countries. Bull World Health Organization. 2001;79:954-62.
IARC Working Group on Cervical Cancer Screening. Summary chapter. In: Hakama M, Miller AB, Day NE, editors. Screening for cancer of the uterine cervix. Lyon:IARC Press:1986:133-42(IARC Scientific Publications no76).
Lorinz AT, Reid R, Jenson AB, Greenberg MD, Lancaster W, Kurman RJ, et al. Human papillomavirus infection of the cervix: relative risk association of 15 common ano genital types. Obstet Gynecol. 1992;79(3):328-37.
Ellerbrock TV, Chiasson MA, Bush TJ, Sun XW, Sawo D, Brudney K et al. Incidence of cervical squamous intraepithelial lesions in HIV-infected women. JAMA. 2000;283(8):1031-7.
Hawes SE, Critchlow CW, Niang MAF, Diop A, Toure P, Dembele B, et al. Increased risk of high grade cervical squamous intraepithelial lesion and invasive cervical cancer among African women with immunodeficiency virus type 1 and 2 infection. J Infectious Dis. 2003;188(4):555-63.
Schuman P, Ohmit SE, Klein RS, Duerr A, Cu-Uvin S, Jamieson DJ et al. Longitudinal study of cervical squamous intraepithelial lesions in human immunodeficiency virus (HIV)-seropositive and at-risk HIV-seronegative women. J Infect Dis. 2003;188(1):128-36.
Devi KP, Priya NB. Conventional Pap smear screening in HIV seropositive women in South India. J Obstet Gynecol India. 2013;63(1):55-8.
Micheletti AM, Dutra VD, Murta EF, Paschoini MC, Silva‐Vergara ML, e Silva GB, et al. Cervicovaginal cytological abnormalities in patients with human immunodeficiency virus infection, in relation to disease stage, CD4 cell count and viral load. Diagnostic Cytopathol. 2009;37(3):164-9.
Six C, Heard I, Bergeron C, Orth G, Poveda JD, Zagury P, et al. Comparative prevalence, incidence and short-term prognosis of cervical squamous intraepithelial lesions amongst HIV-positive and HIV-negative women. AIDS. 1998;12(9):1047-56.
Teixeira NC, Araújo AC, Correa CM, Lodi CT, Lima MI, Carvalho ND, et al. Prevalence and risk factors for cervical intraepithelial neoplasia among HIV-infected women. Brazilian J Infect Dis. 2012;16(2):164-9.
Greenblatt RM, Bacchetti P, Barkan S, Augenbraun M, Silver S, Delapenha R, et al. Lower genital tract infections among HIV-infected and high-risk uninfected women: findings of the Women's Interagency HIV Study (WIHS). Sexually Transm Dis. 1999;26(3):143-51.
Warren D, Klein RS, Sobel J, Kieke B, Brown W, Schuman P, et al. A multi-centric study of bacterial vaginosis in women with or at risk for human immuno deficiency virus infection. Infect Dis Obstet Gyneol. 2001;9(3):133-41.
