Abstract
BackgroundCervical cancer is the leading cause of cancer related death among women in developing countries. Cervical cancer is preceded by cervical surface epithelial cell abnormalities (ECA) which can be detected by Pap smear test. Simultaneous human papillomavirus and human immunodeficiency virus (HIV) infection increases cervical cancer. Data on the prevalence and predictors of ECA among women in Ethiopia is limited. Hence, we aimed to determine the prevalence and associated factors of ECA among women.MethodsA comparative cross-sectional study was conducted among HIV+ and HIV- women attending gynecological examination in cervical cancer screening center at the Debre Markos referral hospital. The study subjects were stratified by HIV status and systematic random sampling method was used to recruit study participants. Cervical smears were collected for Pap smear examination. Logistic regression analysis was employed to examine the possible risk factors of cervical ECA.ResultsA total of 197 HIV+ and 194 HIV- women were enrolled in the study. The overall prevalence of cervical ECA was 14.1 % of which the prevalence of atypical squamous cells undetermined significance (ASCUS), low grade squamous intraepithelial lesion (SIL), high grade SIL, squamous cell carcinoma and ASC, cannot exclude high grade SIL (ASCH) were 5.1, 3.8, 4.1 and 1.0 %, 0.0 % respectively. Significantly higher prevalence of ECA (17.8 %) was observed among HIV+ women (COR 1.9, 95 % CI: 1.1 − 3.4, p = 0.036) as compared to HIV-women (10.3 %). Multiple sexual partnership (AOR 3.2, 95 % CI: 1.1 − 10.0, p = 0.04), early ages of first sexual contact (<15 years) (AOR 5.2, 95 % CI: 1.5 − 17.9, p = 0.009), parity greater than three (AOR 10.9, 95 % CI: 4.2 − 16.8, p < 0.001) and long term oral contraceptive pills (OCP) use (AOR 11.9, 95 % CI: 2.1 − 16.7, p = 0.02) were significant predictors of prevalence of ECA.ConclusionsCervical ECA is a major problem among HIV-infected women. Lower CD4+ T-cell counts of below 350 cells/μl, HIV infection, multiple sexual partnership, early age at first sexual contact, parity greater than three and long term OCP use were significant predictors of prevalence of ECA. Strengthening screening program in HIV+ women should be considered.
Highlights
Cervical cancer is the leading cause of cancer related death among women in developing countries
There was no discrepancy between the results of the laboratory technologist and the pathologist or the gynecologist results except for one sample that was diagnosed as low-grade squamous intraepithelial lesion (LSIL) by the laboratory technologist but as atypical squamous cells undetermined significance (ASCUS) by the pathologist (Table 1)
The study showed that microscopic examination of Pap smear results by a trained laboratory technologist are comparable with the microscopic examination results of the same preparation observed by a pathologist
Summary
Cervical cancer is the leading cause of cancer related death among women in developing countries. Cervical cancer is preceded by cervical surface epithelial cell abnormalities (ECA) which can be detected by Pap smear test. Squamous intraepithelial lesions (SIL) are an abnormal growth of squamous epithelial cells of the ecto-cervix. Cervical epithelial cell abnormalities (ECA) represent a spectrum of SIL that lie along the pathway, from mildto-severe dysplasia to invasive cancer [1]. Greater than 99.7 % cervical cancer is attributed by human papillomavirus (HPV) infection. HRHPV types, HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68 and 82, cause anogenital cancer [6], while infection with LR-HPV types, HPV 6 and 11, is associated with benign genital warts. HR-HPV types are detected in 99 % of cervical cancer, and about 70 % of cervical cancer is due to HPV 16 and 18 [7]
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