16th International AIDS Conference


Toronto, Canada - August 13 - 18, 2006

PREVALENCE AND PREDICTORS OF SQUAMOUS INTRAEPITHELIAL LESIONS OF THE CERVIX IN HIV-INFECTED WOMEN IN LUSAKA, ZAMBIA

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. TuAb0303

G. Parham1, V. Sahasrabuddhe2, S. Vermund2, B. Shepherd2, E. Stringer1, M. Mwanahamuntu3
1 UAB/Center for Infectious Disease Research in Zambia, Lusaka, Zambia, 2 Vanderbilt University, Nashville, United States, 3 University Teaching Hospital, Lusaka, Zambia

BACKGROUND: HIV-infected women are at higher risk for the development of HPV-induced squamous intraepithelial lesions (SIL) of the cervix. HIV-infected women living in resource limited settings like Zambia are now accessing antiretroviral therapy and may live long enough for cervical cancer to manifest and progress. It is important to develop appropriate guidelines for screening in the context of cervical cancer prevention.

METHODS: We evaluated the prevalence and predictors of cervical cytological abnormalities among 150 consecutive, eligible, nonpregnant HIV-infected women accessing HIV-care services in Lusaka, Zambia. A pelvic examination was performed and cervical specimens were analyzed with liquid-based monolayer cytology (Thin Prep Pap Test®: Cytyc Corporation) and testing for HPV using Roche Linear Array® PCR assay.

RESULTS: The median age of study participants was 36 years (range 23 – 49 years) and their mean CD4+ count was 209/µl (S.E. +14.7). The prevalence of SIL was 76% (114/150); 23.3% (35/150) women had low grade SIL, 32.6% (49/150) had high-grade SIL, and 20% (30/150) had lesions suspicious for squamous cell carcinoma (SCC). High-risk HPV types were present in 85.3% (128/150) women. On bivariable analyses, age, CD4+ cell count and presence of any high-risk HPV type were found to be significantly associated with the presence of severely abnormal cytology, i.e., high grade SIL and suspicious for squamous cancer. Multivariable logistic regression modeling suggested the presence of any high-risk HPV type as an independent predictor of severely abnormal cytology (Adjusted OR: 12.4, 95% C.I. 2.62 – 58.1, p=0.02).

CONCLUSIONS: The high prevalence of abnormal squamous cytology in our study is one of the highest reported in any population worldwide. It is essential to develop, implement, and evaluate cost-effective screening tests and appropriate treatment protocols for HIV-infected women in resource limited settings who, on antiretroviral therapy, may live long enough to develop HPV-induced invasive cervical cancer.

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2006-08-13
TuAb0303

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