Abstract

Human papillomavirus (HPV) infection is a necessary factor in the development of cervical intraepithelial neoplasia (CIN) and carcinoma of the cervix. HIV-positive females carry an increased risk of persistent genital HPV infection and therefore have an increased risk of HPV-associated lower genital tract neoplasia, particularly CIN. Cytological screening for cancer of the cervix, specifically precancerous lesions, is generally accepted as being effective in reducing both incidence and mortality of cervical cancer. The study assessed the concordance and discordance (or association) between cervical cytology and histology among retroviral positive females at the Lagos University Teaching Hospital (LUTH). It was carried out at the Morbid Anatomy Department of LUTH and PEPFAR Clinic, LUTH. In all, 314 HIV positive females participated in the study, while 336 HIV negative females were used as controls. The mean age of females in the control group was 35.4 years and that of the control group was 41.6 years. Pap smear abnormalities were seen in 102 (32.5%) females, which included ASCUS (8.3%), LSIL (17.2%) and HSIL (7%). 1.3% of the smears were reported as unsatisfactory. There were no cases of invasive squamous cell carcinoma. The mean age of the LSIL group was 33 years, and that of the HSIL group was 37.5 years. Among the control group, a Pap smear abnormality rate of 5.4% was seen, which included ASCUS (3.6%), LSIL (0.3%), HSIL (1.5%). 10.8% of the smears were reported as unsatisfactory. In this group, the mean age of females with ASCUS was 45 years, LSIL 52 years and HSIL 41.5 years. Of the 102 women with Pap smear abnormalities, only 35 (34%) turned up for further evaluation with colposcopy and biopsy, and the remaining 67 (66%) were lost to follow up. The results of these biopsies showed normal histology in 1 case, CIN I in 27 cases, CIN II in 1 case, CIN III in 2 cases, and was unsatisfactory in 4 cases. A very high concordance rate (96.3%) between the cytological and histological findings, to within one histological grade of cervical intraepithelial neoplasia (CIN), was noted in the LSIL and ASCUS groups. However, among the 4 HSIL cases, a 75% concordance rate was noted.