Cervical cytological patterns among HIV infected women on antiretroviral therapy at Kenyatta national hospital.

Abstract

Introduction: HIV infection and HPV Persistence in immunosuppressed individuals is associated with development of cervical dysplasia and invasive cervical carcinoma. Combined Antiretroviral therapy (cART) has been shown to cause either regression or progression of cervical cytological lesions. Objective: The aim of the study was to determine the cervical cytological patterns in HIV infected women on long term use over 5 years of cART. Methodology: A cross sectional study. Pap smears were collected from two hundred and ten (210) HIV infected women on cART during November 2015-March 2016. CD4 cell counts and HIV viral loads were obtained from patient records at Comprehensive Care Clinic. Bivariate analysis correlated the cervical cytological lesions with CD4 cell counts, HIV viral loads and long term use of cART. Results: Out of 210 HIV infected women sampled; the mean age was 42 years (SD=8.3). Age range was 24-61 years. The prevalence of cervical cytological lesions was 9.9%.Commonest lesion reported was high grade squamous intraepithelial lesion (HSIL) with 6%, followed by atypical squamous cells of undetermined significance(ASCUS), low grade squamous intraepithelial lesions(LSIL) and squamous cell carcinoma(SCC) having 1%. The distribution of the cervical cytological lesions was 2 with LSIL, 16 with HSILs. Infections occurred as follows twenty three patients had candida, seventeen had bacterial vaginosis, ten had co-infection, eighteen had atrophic cervicitis, three had atrophy and sixteen which amounted to 41%.The average duration on cART was 5-9 years (38.9%), 16% over duration of 10 years. The mean distribution of CD4 cell counts in the positive cytological lesions was 492.9/mm³, with 62.5% with HIV viral loads of less than 500. The women with positive cytological abnormalities with 200 cells/mm³ and below, were 66.7%. Conclusions: This study demonstrated a reduction of cervical cytological lesions in HIV infected women on cART. The high grade cervical cytological lesions were leading followed by LSIL in this setting. In the development of cervical cytological lesions there was no statistical difference in the women with a history of cervical screening and those with no history. Recommendations: Periodic Pap smear screening for all HIV infected women because VIA/VILLI is not specific. A larger study should be conducted to determine the long term effect of cART on cervical cancer