A comparison of risk factors for atypical squamous cells and squamous intraepithelial lesions in a sample of US- and African-born HIV-positive women

Abstract

Previous research conducted in the USA and Africa has identified human immunodeficiency virus (HIV) infection as a risk factor for women developing squamous intraepithelial lesion (SIL) diagnosis. This study was conducted to compare the odds of a diagnosis of atypical squamous cells (ASCUS) or SIL in a sample of mostly African-born and US-born women (n=275). A greater proportion of US-born women had an ASCUS (68.9%) or SIL (81.3%) diagnosis than African-born women (29.5% ASCUS, 15.6% SIL). After adjusting for age, smoking status, absolute CD4, and a prescription for HIV-antiviral medications, the US-born women had a greater odds of a SIL diagnosis than the African-born women (OR=0.22, 95% CI: 0.06–0.79); no significant differences in ASCUS remained after adjustment. In this sample, proportionately more African-American (55.3%) and white American (51.1%) women smoke tobacco than African-born women (1.9%), explaining, perhaps, some of the difference. We found that an absolute CD4 less than 200, when compared to an absolute CD4 above 500, was highly predictive of a SIL diagnosis (OR=6.31, 95% CI: 2.10–18.93, p-trend <0.01). A prescription for HIV-antiviral medications was not a significant predictor of an ASCUS or SIL diagnosis.