The association between HIV infection, antiretroviral therapy and cervical squamous intraepithelial lesions in South Western Nigerian women.

Oliver Chukwujekwu Ezechi,Oliver Chukwujekwu Ezechi,Per Olof Ostergren,Innocent Achaya O Ujah,Clement Abu Okolo,Karen Odberg Pettersson,Luis Menéndez-Arias

doi:10.1371/journal.pone.0097150

Oliver Chukwujekwu Ezechi, Oliver Chukwujekwu Ezechi + Show 5 more

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https://doi.org/10.1371/journal.pone.0097150

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Abstract

IntroductionFindings from studies that evaluated the effect of antiretroviral drug use on the development of cervical squamous intraepithelial lesion differed in their conclusions. This study investigated the association between HIV infection, antiretroviral drug use and cervical squamous intraepithelial lesion in a high HIV and cervical cancer burden setting- Nigeria.MethodsA cross sectional study among 1140 women of known HIV status enrolled in a randomised study to determine the test characteristics of visual inspection in detecting cytology diagnosed squamous intraepithelial lesion. Multivariate analysis was used to determine the association between HIV infection, antiretroviral drug use and the twin outcome variables of cervical squamous intraepithelial lesion (SIL) and High grade squamous intraepithelial lesion (HSIL) while controlling for confounders.ResultsPrevalence of cervical squamous intraepithelial lesion was 8.5%, with a higher prevalence of 14.3% in HIV positive compared to 3.3% in HIV negative women (aOR: 5.4; 95% CI: 2.9–8.8). Not using antiretroviral drugs was found to be associated with an increased risk of SIL (aOR: 2.1; 95% CI: 1.4–3.5) and HSIL (aOR: 2.6; 95% CI: 1.1–6.4). Participants who had a CD4 cell count <200 cells/mm3, were also found to be at increased risk for SIL (aOR: 1.9; 95% CI: 1.1–5.9) and HSIL (aOR: 5.7; 95% CI: 1.1–7.2).ConclusionHIV infection and severe immunosuppression were found to be associated with increased risk of cervical squamous intraepithelial lesion but not viral load. For the first time, in the West African sub-region with specific HIV type and strains, we established the protective effect of antiretroviral drug use against the development of SIL. Integration of cervical cancer screening programme into HIV services and early initiation of antiretroviral drug in HIV positive women especially those with severe immune-suppression could therefore prove to be useful in preventing and controlling cervical cancer development in HIV positive women.

Highlights

Findings from studies that evaluated the effect of antiretroviral drug use on the development of cervical squamous intraepithelial lesion differed in their conclusions
We investigated the association between HIV infection, immunosuppression, antiretroviral drug use and cervical squamous intraepithelial lesions in a setting endemic for both HIV and cervical cancer
The 1140 (98.6%; 531 HIV positives and 609 HIV negatives) women with cytology reports were included in the analysis

Summary

Introduction

Findings from studies that evaluated the effect of antiretroviral drug use on the development of cervical squamous intraepithelial lesion differed in their conclusions. This study investigated the association between HIV infection, antiretroviral drug use and cervical squamous intraepithelial lesion in a high HIV and cervical cancer burden setting- Nigeria. Despite availability of studies that examined the effects of antiretroviral drug use on the course of cervical lesions in HIV positive women, the impact of the use of antiretroviral drug on the course of cervical lesions remains somewhat unclear [7,8,9,10,11,12,13]. The inconsistency of findings in the cited studies might be the effect of small sample size, differing analytic techniques, viral diversity as well as timing and duration of treatment with antiretroviral drugs [14,17]

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