Risk factors of abnormal visual cervical inspection in HIV infected women on antiretroviral treatment.

Abstract

Background: HIV infected patients have a higher likelihood of multiple oncogenic HPV sub-types, get persistent HPV infections and progress faster to invasive cancer compared to their HIV uninfected counterparts. Unresolved HPV infection is the major cause of invasive cervical cancer. In Kenya, cervical cancer screening is opportunistic and not systematically done as in developed countries. Due to the challenges posed by the Pap smear protocol, the Kenyan Ministry of Health rolled out the visual cervical cancer screening with acetic acid and Lugol’s iodine (VIA/VILI), yearly for HIV infected women. VIA/VILI is more sensitive but less specific than cytology in detection of cervical cancer and its pre–cancerous lesions. VIA/ VILI has acceptable test qualities and may in low resource settings be implemented as a large scale screening method. Broad objective: To determine the factors associated with abnormal VIA/VILI among HIV infected women in KNH Comprehensive Care Clinic (CCC). Study design: an unmatched case control study, with a ratio of 1:1 for cases to controls. Cases were HIV infected women with abnormal VIA/VILI screen while controls were patients who had no abnormalities on VIA/VILI screen. Cases and controls were compared for risk factors associated with abnormal VIA/VILI result. Study setting: KNH CCC. Study participants: HIV infected women who had undergone VIA/VILI at the CCC. Analysis: Descriptive univariate statistics was calculated to summarize characteristics of HIV infected women (socio-demographic and clinical) according to findings of cervical visual inspection. Results: The mean age of participants with abnormal VIA /VILI results was 40.9 years compared to 43.5 years in participants with normal findings. Women aged 50-59 years were less likely to have abnormal VIA/VILI OR 0.29; p<0.001; 95%CI 0.15-0.57. Those who had a CD4 count less than 500 cells/mm3 were more likely to have an abnormal VIA/VILI OR 1.65; p=0.017; 95CI 1.1-2.5. CD4 Counts less than 200 were also more likely to have an abnormal VIA/VILI result to a larger extent than those women with CD4 counts less than 500 cells/mm3 OR 2.74; p=0.028; 95CI 1.12-6.73. Due to missing data the association between ARV regimen and abnormal VIA/VILI was inconclusive. The following were not associated with an abnormal VIA/VILI: marital status, WHO clinical staging, body mass index and AIDS defining illness. Conclusion: Our study revealed a high prevalence of abnormal VIA/VILI among the study participants, and a high abnormal VIA/VILI risk for participants with low CD4 count less than 500 cells/mm3.