Risk factors for cervical squamous intraepithelial lesions among HIV-1 seropositive women in Dar es Salaam, Tanzania

Abstract

Objectives: To determine the prevalence and risk factors for cervical squamous intraepithelial lesions (SIL) among HIV-infected women in Dar es Salaam, Tanzania. Methods: Between July 1996 and December 1997 we interviewed 691 HIV-infected women to obtain information about risk factors for SIL. Cervical smears and samples for lymphocyte subsets and sexually transmitted diseases (STD) diagnosis were collected. Results: The prevalence of SIL was 2.9% (20/686) (95% CI=1.7–4.2%). Eleven women had low-grade SIL while nine women had high-grade SIL. The number of lifetime sexual partners and live births was associated with a marginally non-significant increased risk of SIL. The risk of SIL was significantly increased among women with CD4+ cell count <200/mm3 (multivariate odds ratio (OR)=6.15, 95% CI=1.19–41.37) and decreased by 68% for each 5-cm increase in mid-upper arm circumference (multivariate OR=0.32, 95% CI=0.10–0.93). Conclusions: HIV-related immunosuppression and wasting and long-term sexual behavior were the major determinants of SIL in this population.