Prevalence and Risk Factors Associated with Precancerous Cervical Cancer Lesions among HIV-Infected Women in Resource-Limited Settings

Peter Memiah,Grace Kiiru,Sylvia Ojoo,Wangeci Mbuthia,Francesca Odhiambo,Solomon Agbor,Sibhatu Biadgilign

doi:10.1155/2012/953743

Abstract

Objective. To assess the prevalence and identified associated risk factors for precancerous cervical cancer lesions among HIV-infected women in resource-limited settings in Kenya. Methods. HIV-infected women attending the ART clinic at the Nazareth Hospital ART clinic between June 2009 and September 2010. Multivariate logistic regression model with odds ratios and 95% confidence intervals (CI) were estimated after controlling for important covariates. Result. A total of 715 women were screened for cervical cancer. The median age of the participants was 40 years (range 18–69 years). The prevalence of precancerous lesions (CINI, CINII, CIN III, ICC) was 191 (26.7%). After controlling for other variables in logistic regression analysis, cervical precancerous lesions were associated with not being on ART therapy; whereby non-ART were 2.21 times more likely to have precancerous lesions than ART patients [(aOR) = 2.21, 95% CI (1.28–3.83)]. Conclusion. The prevalence of precancerous cervical lesions was lower than other similar settings. It is recommended that cancer screening of HIV-infected women should be an established practice. Availability and accessibility of these services can be done through their integration into HIV. Prompt initiation of HAART through an early enrollment into care has an impact on reducing the prevalence and progression of cervical precancerous lesions.

Highlights

Cervical cancer is the second most common malignancy and accounts for the greatest number of deaths from cancer in women worldwide [1]
The mechanism by which Human immunodeficiency virus (HIV) increases risk of cervical cancer is not completely understood, studies suggest that HIV-induced immunosuppression leads to an inability to control the expression of HPV and the production of HPV oncoproteins E6 and E7 [25, 26] and the risk appears to be associated with increased HPV persistence that may result from immunosuppression related to HIV
Studies have shown that HIV-1 infection is associated with an increased rate of HPV infection, mainly restricted to HR-HPV types which are the cause of invasive cancer of the cervix [28,29,30]

Summary

Introduction

Cervical cancer is the second most common malignancy and accounts for the greatest number of deaths from cancer in women worldwide [1]. Women in developing countries are at greater risk of death from cervical cancer primarily because few have access to the screening and treatment services that have greatly reduced mortality in the industrialized world over the past four decades. About 75% of women in industrialized countries has been screened for cervical cancer in the previous five years, compared to less than 5% in developing countries [3]. According to WHO (1986), it has been estimated that only about 5% of women in developing countries has been screened for cervical dysplasia in the past 5 years, compared with 40% to 50% of women in developed countries [4]. The public health importance of assessing the interaction between HIV and HPV infection with respect to cervical disease is suggested by increased rates of dysplasia persistence and recurrence among HIV-positive women and shorter survival for women with HIV infection and cervical cancer [9]

Methods

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Discussion

Conclusion