COMPARATIVE STUDY ON THE INCIDENCE AND RISK FACTORS OF CERVICAL DYSPLASIA AMONG HIV POSITIVE AND HIV NEGATIVE WOMEN AT AMINU KANO TEACHING HOSPITAL

Abstract

Background HIV infection is a risk factor for cervical cancer and both diseases are prevalent in Nigeria. HIV positive women are at greater risk of cervical dysplasia than HIV negative women which may be as a result of immunosupression, hence adding more burden to their already worsening health. It has become relevant to screen these women early and refer for appropriate and effective therapeutic intervention. Aims/Objective To compare the incidence and risk factors of cervical dysplasia among HIV positive and HIV negative women at Aminu Kano Teaching Hospital, Kano. Research Methods This was a comparative cross sectional study conducted at Aminu Kano Teaching Hospital, which involved HIV positive women attending HIV clinic and HIV negative women attending the gynecological clinic at Aminu Kano Teaching Hospital. A cohort of consenting 150 HIV positive women not on HAART and 150 HIV negative women , which had been selected by systematic random sampling were sent for Pap smear examination. On the same day blood samples were taken from antecubital vein and sent for both CD4 count and viral load among the HIV positive group. A pretested questionnaire was administered to the women of both groups on same day to determine the presence or absence of risk factors of cervical dysplasia in them. The results obtained were recorded using proforma and analyses of risk factors of cervical dysplasia was done using Chi square test and Fisher exact test to compare variables between those with normal and abnormal smears and student t test to determine the relationship of lesions with CD4count and viral load among the HIV positive women.
Planned handling of Results The incidence cervical dysplasia among HIV positive women was 49 (32.7%) and was significantly higher than 12(8%) found among the HIV negative. Age ≥ 35years and parity ≥5, early coitarche, multiple sexual partners, low-socioeconomic status, cigarette smoking did confer some risk of dysplasia however, use of hormonal contraception did not. This study also showed that among the HIV positive group, CD4 count was inversely associated with risk of cervical dysplasia and women with a CD4 count <500 cells/mm3 were at greater risk of cervical dysplasia compared with women with CD4counts>500 cells/mm3. Furthermore, viral load >10,000 copies/ml was associated with cervical dysplasia and higher grade lesions .Those who had abnormal smears were referred to gynaecology clinic for further evaluation. Conclusion It can be concluded from this study that not only is there need to carry out cervical smear screening for all women, the need is even more pressing for the HIV positive especially those with a CD4 count<500 at first contact.

COMPARATIVE STUDY ON THE INCIDENCE AND RISK FACTORS OF CERVICAL DYSPLASIA AMONG HIV POSITIVE AND HIV NEGATIVE WOMEN AT AMINU KANO TEACHING HOSPITAL