Prevalence of pre-malignant cervical lesions among Hiv-positive women on haart attending home care clinic at St. Francis hospital Nsambya, Uganda.

Abstract

Background Cervical cancer is the most prevalent cancer among women and the leading cause of cancer related mortality in Uganda. In sub-Saharan Africa, one in six women will develop cancer during their lifetime, and one in eleven will die from it. Cervical precursor lesions are associated with human immunodeficiency virus (HIV) among women on highly active antiretroviral therapy due to persistent human papilloma virus (HPV) infection. Low-grade squamous intraepithelial lesion (LSIL), atypical squamous cells of undetermined significance (ASCUS), and high-grade squamous intraepithelial lesion (HSIL) have been the most frequent precursor lesions. However, the prevalence and correlations with other variables have not been documented among women living with HIV on HAART in Uganda. Study objectives To determine the prevalence and distribution of pre-malignant cervical lesions on Pap smear among HIV-positive women on HAART for three (3) years or more attending Home Care Clinic at St. Francis Hospital, Nsambya, in Uganda. Materials and Method A cross-sectional descriptive study was carried on HIV-positive women on HAART aged 18 to 69 years attending the Home Care Clinic (HCC) of St. Francis Hospital Nsambya between December 2019 and February 2020. They were examined for precursor cervical lesions on Pap smear. Socio-demographic and clinical information was obtained through a questionnaire. The baseline CD4 count and viral load were abstracted from the daily activity register. The data were entered using Microsoft Excel spreadsheets and analysis done using R-software version 3.6.2 (2019). Logistic regression was done, and results were presented in tables, pie charts, histograms, and photomicrographs. Results Two hundred and ten (210) women were enrolled in the study, and a Pap smear was carried out in all of the participants and samples sent to the laboratory. Abnormal smears were reported in 12 (5.7%) of the women. The most common finding was ASC-US (2.4%) followed by LSIL (1.9%), while the rest of the women had atypical squamous cells cannot exclude high-grade (ASC-H), squamous cell carcinoma (SCC), and Adenocarcinoma lesions with 0.5% each. Interestingly SCC and adenocarcinoma were observed in the lower age group of between 30 to 39 years. Bacterial vaginosis, found in 24.8% of the study participants, was the most common infection, followed by Candidiasis which was observed in 8.1% of the subjects. Conclusion There was a low prevalence of pre-malignant cervical lesions among women living with HIV attending HCC of St. Francis Hospital, Nsambya, in Uganda. The study did not find a statistically significant relationship between the premalignant cervical lesions with the duration on HAART and viral loads.