Prevalence and Risk Factors of Cervical Dysplasia among Human Immunodeficiency Virus Sero-Positive Females on Highly Active Antiretroviral Therapy in Enugu, Southeastern, Nigeria

Document Type: Research Articles

Authors

1 Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria Nsukka, Nigeria.

2 Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria Nsukka, Nigeria.

Abstract

Objective: Evaluation of prevalence and risk factors of cervical dysplasia among Human Immunodeficiency Virus
sero-positive (HIV+ve) females on Highly Active Antiretroviral Therapy (HAART) attending HIV clinic at University of
Nigeria Teaching Hospital (UNTH) Enugu, Southeastern, Nigeria. Methods: Structured questionnaire was used to obtain
socio-demographic and risk factors data. Cervical specimens were collected from 105 HIV +ve females on HAART and
104 HIV seronegative (HIV–ve) females. Pap smears were collected using cytobrush and Ayre’s spatula in a secluded
place. Smears were made on slides and placed in 95% ethyl alcohol for conventional Pap staining and the cytobrush
washed into the preservative containers for later Immunocytochemistry staining. Blood samples were used for HIV
screening. Immunocytochemistry activity using anti-P16INK4A was carried out on the Pap smears that were positive
for cervical dysplasia. Results: Pap staining showed prevalence of cervical dysplasia among HIV+ve on HAART
19.05%, (ASCUS 14.29%, LSIL 3.81%, HSIL 0.95%) whereas HIV-ve was 6.73%, p = 0.008. Only the HSIL 0.95%
was positive for P16INK4A. Odds ratios at 95% Confident Interval of the risk factors of cervical dysplasia were thus;
HIV+ve, 3.26 (1.31-8.09), education less than secondary school 3.23 (1.25-8.37), polygamy 3.23 (1.25-8.37), smoking
1.36 (0.15-12.10), married 2.08 (0.43-2.31), grand multi gravidity 1.72 (0.72-4.11), grand multi parity 1.54 (0.66-3.61),
positive history of sexually transmitted diseases 2.49 (1.06-5.80). Uptake of cervical cancer screening was low in both
study groups, 7 (6.7%) among HIV+ve on HAART and 14 (13.5%) among HIV-ve females, P = 0.102. Conclusion:
HAART had cytoprotective effect against cervical dysplasia in HIV+ve females, by reducing progression of ASCUS to
LSIL, HSIL and cervical cancer. Progression from normal to ASCUS increased which could be due to latency or/and
prolonged persistent high risk HPV and HIV infections, of the most sexually active age group before diagnosed of HIV.

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