Prevalence of cervical cytological abnormalities and human papilloma virus infection among renal transplant recipients at Kenyatta national hospital

Abstract

Background Renal transplant began in the 1950‟s. Over the years more specialists have been trained and as a result more transplants are done each year and with the improved post transplant care and immunosuppressant therapy, these patients have longer survival rates. As a consequence of this, a resurgence of latent forms of viral infections occurs, in this regard human papillomavirus, leading to an upsurge of anogenital malignancies such as cervical cancer, vulval cancer and anal cancer. The risk of cervical cancer increases by 14 fold in renal transplant recipients yet this can be prevented with more vigilant cervical cancer screening. Early detection of precancerous lesions can lead to timely treatment and reduce the burden of disease that may occur as a result of multiple illnesses. Owing to the multiplicity of complications associated with renal transplant, cervical cancer screening may take a back seat in this population. This study will determine the prevalence of HPV and cervical cytological abnormalities in the renal transplantation population in a bid to emphasize the need for yearly cervical cancer screening. Broad Objective The main objective of this study was to determine the prevalence of cervical cytological abnormalities and HPV infection in renal transplant recipients at KNH. Methods This was a cross-sectional study to determine the prevalence of cervical cytological abnormalities and HPV infection among renal transplant recipients. Data collection was done by the principal investigator and individuals were identified through consecutive sampling. A consent form was filled followed by administration of a structured questionnaire to assess the socio-demographic, reproductive and clinical history of participants. Thereafter, a pap smear and liquid based cytology sample for collection of HPV was done. Data was analysed using SPSS version 22, t-test and chi test for the continuous and categorical variables, Fischer‟s test and chi square was used for associations. xv Results Thirty two female renal recipients who met the eligibility criteria were enrolled into the study. There median age was 38.5 years (range 24-64 years). The mean duration since transplant was 4.89 years (SD 5.15). The prevalence of hrHPV infection was 33% (10/32) whereas the prevalence of abnormal cervical cytology was 12.5% (4/32)). The marital status, parity and lifetime number of partners were found to be statistically significant Conclusion The prevalence of premalignant cervical lesions and hrHPV infection was found to be high among female renal transplant recipients attending the post transplant clinic at KNH. Though few, these findings raise awareness of the magnitude of this problem among this population. The use of immunosuppressive therapy is also inevitable, however health awareness measures aimed at preventing the acquisition of HPV and other STIs as well as reduction in the number of sexual partners will greatly impact on the occurrence of HPV and subsequent premalignant cervical lesions in this population. Moreover, these findings should generate interest for future studies in order to engage best practices in screening and managing premalignant cervical lesions among renal transplant recipients.