Prevalence of cervical cytology abnormalities among HIV infected women at Rwanda military hospital: a cross-sectional descriptive study.

Abstract

Cervical cancer is the second most common cancer in women worldwide and it is ranked second to cancer of the breast in developing countries whereas in developed countries cervical cancer is ranked fifth. Studies now clearly demonstrate an increased risk of precancerous cervical lesions and a more rapid progression to cancer amongst HIV infected women particularly those with low CD4 cell counts or decreasing immunity. Effective cytological screening and follow up intervention programs have been credited for the sharp decline in its prevalence in Europe and North America. This has not been the case in the developing world where resources and infrastructure have proved insufficient to offer quality screening and appropriate follow-up. In Rwanda, there is no study that has previously determined the prevalence of abnormal Pap smear in HIV infected women hence a reason why we carried out this study. Objectives: To determine the prevalence of abnormal Pap smears in HIV-positive women attending HIV- clinic at Rwanda Military Hospital. To determine the correlation between CD4+ cell count and abnormal Pap smear among HIV infected women at Rwanda Military Hospital. To determine the correlation between WHO-HIV staging and abnormal pap smear among HIV-infected women at Rwanda Military Hospital. Methods: This was a cross-sectional descriptive study which was aimed at determining the prevalence of cervical cytology abnormalities among HIV-infected women at Rwanda Military Hospital. Women who were eligible for the study and willing to participate consented. They were recruited by consecutive sampling. After filling the questionnaire that had social demographics and also other data were collected from their Medical records, a Pap smear was done to whoever fulfilled the study criteria. Results: Between March and June, 2013 a total of 293 women infected with HIV had cervical smear taken for cytology. Of the 293 women who were recruited for the study, cervical SIL were present in 58 (20%). Of those with cervical SIL, 33 (56.89%) women had low-grade SIL, 15(25.86%) had ASCUS, 6(10.34%) had high-grade SIL, 3(5.17%) had SCC and 1(1.72%) had AGC-H. A CD4 lymphocyte count of <200 cells/mm3 was found to be significantly associated with cervical SIL. In the current study, use of ARV drugs was not associated with a reduction in the risk of cervical SIL Conclusion: A high prevalence of cervical SIL was found among HIV-infected women at Rwanda Military Hospital-Rwanda. Increased immune suppression was significantly associated with cervical SIL. Recommendation: Due to the high prevalence reported in this study, routine screening of all women should be done with much emphasis to be put in for the HIV-infected group. Patients who were found to have an abnormal Pap smear were referred to the hospital’s Gynecology Out Patient Clinic for further follow up. The government through the ministry of Health should create awareness to the public about cancer of the cervix.