The Prevalence Of Abnormal Cervical Cytology In Hiv Positive Mothers At Six Weeks Postpartum At K.N.H

Abstract

Cancer of the cervix is one of the leading causes of morbidity and mortality among women especially in the developing world where cervical cytology screening is not readily available to the general population. Cervical intraepithelial neoplasia (CIN) precedes invasive disease by many years and is amenable to treatment by either ablation or excision procedures. The prevalence is even higher in HIV positive women and disease progression from CIN to ICC is faster. In a set up like ours where population based screening is low, postnatal clinic especially for the HIV positive mothers provide an opportunity for cervical cytology screening.

To determine the prevalence of abnormal cervical cytology and VIA findings among HIV positive women at 6 weeks postpartum at KNH.

Among HIV positive mothers at 6 weeks postpartum; 1. Describe cervical cytology findings. 2. Describe vaginal examination findings including VIA. 3. Compare cervical cytology and VIA findings.

Between 18th April and 17th October 2008, 175 postnatal HIV positive mothers seeking postnatal care services at KNH were interviewed, their cervix examined by VIAand evaluated for abnormal cervical cytology by Pap smear.

Sixty five (37%) of the women enrolled had abnormal cervical cytology,with 95% being squamous cell abnormalities, 9% ASCUS, 7%AGUS, 17% LSIL, 6% HSIL and 3%SCC. Sixty eight (39%) women had positive results by VIA. In 25% of the smears, infections or bacterial vaginosis was reported. There was moderate agreement between VIA and Pap smear.

Cervical cytology abnormalities and VIA abnormalities are common in HIV positive mothers as determined by both postpartum Pap smear cytology and VIA.

There is need to strengthen cervical cytology screening including pelvic examinations for infections in HIV positive mothers.