AEGiS-13IAC: Prevalence of cervical neoplasia among Zimbabwean women in an HIV/STI prevention study.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Prevalence of cervical neoplasia among Zimbabwean women in an HIV/STI prevention study.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrB232)

Chirenje ZM, Loeb L, Mwale M, Masona D, Khumalo-Sakutukwa GN, Padian N
Z M. Chirenje, UZ-UCSF Collaborative Research Programme, 15 Phillips, Belgravia, Harare, Zimbabwe, Tel.: +263.4.704 890, Fax: +263.4.704 897, E-mail: liseouz-ucsf.co.zw

BACKGROUND: Cervical neoplasia occurs with increased frequency among HIV positive women. With the current Zimbabwean HIV epidemic, a large portion of HIV infected women could be harboring cervical precancer cells which are known to have a rapid progression to invasive cancer. Zimbabwean women have one of the highest recorded age-standardized rates of cervical cancer in the world (67 per 100,000), with less than 5% cervical cancer screening coverage. The objective of this analysis is to determine the prevalence of cervical neoplasia among HIV positive women relative to an HIV negative control group.

METHODS: Five hundred and fifty four women aged 18-54 years were enrolled in an HIV/STI prevention study between January 1999 and November 1999. Medical histories, interviews, and specimens for cervical cytology (Papanicolaou smear) and HIV-1 serology were obtained after pre-test counseling. Women with high-grade squamous intraepithelial neoplasia (HSIL) were provided with colposcopy and appropriate treatment according to local criteria.

RESULTS: Prevalence of HIV-1 was 36.8%. Cervical cytology was abnormal in 24.0% of HIV infected women (12.7% atypical cells of undetermined significance 'ASCUS', 8.8% low-grade squamous intraepithelial lesions 'LSIL', 2.5% high-grade squamous intraepithelial lesions 'HSIL'), but in only 6.4% of HIV-1 seronegative women (4.6% ASCUS, 1.1% LSIL, 0.3% HSIL). Using a chi square test statistic with Yates's continuity correction, the prevalence of cervical noeplasia (LSIL or HSIL) was significantly associated with HIV infection (x2 = 24.02, p > .001), and the association was significant. However, because of the cross-sectional nature of the data, we cannot determine whether HIV or cervical neoplasia occurred first. Regardless, HIV endemic countries like Zimbabwe, that also have a high prevalence of HPV, should urgently institute effective and accessible screening policies and procedures.

Keywords: AEGIS, Prevalence, Cervical Intraepithelial Neoplasia, Cervix Neoplasms, Vaginal Smears, HIV Seropositivity, Papillomavirus, Human, HIV Infections, Colposcopy, HIV-1, Cervix Uteri, Mass Screening, Zimbabwe, Human, Female, epidemiology
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MoOrB232