Individual and sexual partner characteristics may increase the risk of abnormal cervical cytology among women in human immunodeficiency virus (HIV)-discordant relationships. Papanicolaou smears were obtained in a prospective cohort of Kenyan HIV-discordant couples. Of 441 women, 283 (64%) were HIV-infected and 158 (36%) were HIV-uninfected with HIV-infected partners. Overall, 79 (18%) had low-grade and 25 (6%) high-grade cervical abnormalities. Male herpes simplex virus type 2 (HSV-2) seropositivity and lower couple socioeconomic status were associated with cervical abnormalities (p < 0.05). HIV-uninfected women with HIV-infected male sex partners (CD4 > 350 cells/µL) had the lowest prevalence of high-grade cervical lesions. HIV-infected women (CD4 > 350 cells/µL) and HIV-uninfected women with HIV-infected partners (CD4 ≤ 350 cells/µL) were at similar intermediate risk (p > 0.05), and HIV-infected women (CD4 ≤ 350 cells/µL) had significantly higher risk of high-grade cervical abnormalities (p = 0.05). Women in HIV-discordant relationships have high rates of cervical lesions and this may be influenced by couple-level factors, including HIV status and CD4 count of the infected partner.
WHO/ICO. Human papillomavirus and related cancers in Kenya: Summary Report 2010. www.who.int/hpvcentre (accessed July 2010).
2.
BoschFLorinczAMuñozN. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol2002; 55(4): 244–265.
3.
WalboomersJJacobsMManosM. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol1999; 189(1): 12–19.
4.
PalefskyJHollyE. Chapter 6: Immunosuppression and co-infection with HIV. J Natl Cancer Inst2003; 31: 41–46.
5.
KreimerAAlbergADanielR. Oral human papillomavirus infection in adults is associated with sexual behavior and HIV serostatus. J Infect Dis2004; 189(4): 686–698.
6.
HagenseeMCameronJLeighJ. Human papillomavirus infection and disease in HIV-infected individuals. Am J Med Sci2004; 328(1): 57–63.
7.
CritchlowCHawesSKuypersJ. Effect of HIV infection on the natural history of anal human papillomavirus infection. AIDS1998; 12(10): 1177–1184.
8.
PalefskyJ. Human papillomavirus infection and anogenital neoplasia in human immunodeficiency virus-positive men and women. J Natl Cancer Inst19982315–20.
9.
MuñozNCastellsaguéXde GonzálezA. Chapter 1: HPV in the etiology of human cancer. Vaccine2006; 24(suppl 3): S3/1–10.
10.
ChaturvediAMadeleineMBiggarR. Risk of human papillomavirus-associated cancers among persons with AIDS. J Natl Cancer Inst2009; 101(16): 1120–1130.
11.
RezzaGGiulianiMBrancaM. Determinants of squamous intraepithelial lesions (SIL) on Pap smear: the role of HPV infection and of HIV-1-induced immunosuppression. DIANAIDS Collaborative Study Group. Eur J Epidemiol1997; 13(8): 937–943.
12.
FrischMBiggarRGoedertJ. Human papillomavirus-associated cancers in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. J Natl Cancer Inst2000; 92(18): 1500–1510.
13.
HeardITassieJSchmitzV. Increased risk of cervical disease among human immunodeficiency virus-infected women with severe immunosuppression and high human papillomavirus load(1). Obstet Gynecol2000; 96(3): 403–409.
14.
GrulichAvan LeeuwenMFalsterM. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet2007; 370(9581): 59–67.
15.
YamadaRSasagawaTKirumbiL. Human papillomavirus infection and cervical abnormalities in Nairobi, Kenya, an area with a high prevalence of human immunodeficiency virus infection. J Med Virol2008; 80(5): 847–855.
16.
UNAIDS. Report on the global HIV/AIDS epidemic 2008.World Health Organization, Geneva, 2008.
17.
LingappaJLambdinBBukusiE. Regional differences in prevalence of HIV-1 discordance in Africa and enrollment of HIV-1 discordant couples into an HIV-1 prevention trial. PloS One2008; 3(1): e1411–e1411.
18.
MbulawaZCoetzeeDMaraisD. Genital human papillomavirus prevalence and human papillomavirus concordance in heterosexual couples are positively associated with human immunodeficiency virus coinfection. J Infect Dis2009; 199(10): 1514–1524.
19.
GuthrieBLLohman-PayneBLiuAY. HIV-1-specific enzyme-linked immunosorbent spot assay responses in HIV-1-exposed uninfected partners in discordant relationships compared to those in low-risk controls. Clin Vaccine Immunol2012; 19(11): 1798–1805.
SolomonDDaveyDKurmanR. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA2002; 287(16): 2114–2119.
22.
HolmesRHawesSTouréP. HIV infection as a risk factor for cervical cancer and cervical intraepithelial neoplasia in Senegal. Cancer Epidemiol Biomarkers Prev2009; 18(9): 2442–2446.
23.
HawesSCritchlowCFaye NiangM. Increased risk of high-grade cervical squamous intraepithelial lesions and invasive cervical cancer among African women with human immunodeficiency virus type 1 and 2 infections. J Infect Dis2003; 188(4): 555–563.
24.
MoodleyJHoffmanMCarraraH. HIV and pre-neoplastic and neoplastic lesions of the cervix in South Africa: a case-control study. BMC Cancer2006; 6: 135–135.
25.
DenslowSARositchAFFirnhaberC. Incidence and progression of cervical lesions in women with HIV: a systematic global review. Int J STD AIDS2014, pp. 163–177.
26.
ChopraKTyringS. The impact of the human immunodeficiency virus on the human papillomavirus epidemic. Arch Dermatol1997; 133(5): 629–633.
27.
JongEvan GorpEMulderJ. Effect of HIV viral load, CD4 cell count and antiretroviral therapy on human papillomavirus prevalence in urine samples of HIV-infected men. Int J STD AIDS2009; 20(4): 262–264.
28.
AdewuyiSShittuSRafindadiA. Sociodemographic and clinicopathologic characterization of cervical cancers in northern Nigeria. Eur J Gynaecol Oncol2008; 29(1): 61–64.
29.
TauloFMalungaENgwiraA. Audit of gynaecological cancers Queen Elizabeth Central Hospital, Blantyre. Malawi Med J2008; 20(4): 140–142.
30.
RostadBScheiBda CostaF. Risk factors for cervical cancer in Mozambican women. Int J Gynaecol Obstet2003; 80(1): 63–65.
31.
DomingoEDy EchoA. Epidemiology, prevention and treatment of cervical cancer in the Philippines. J Gynecol Oncol2009; 20(1): 11–16.
32.
GuptaSSodhaniPSharmaA. Prevalence of high-risk human papillomavirus type 16/18 infection among women with normal cytology: risk factor analysis and implications for screening and prophylaxis. Cytopathology2009; 20(4): 249–255.
KamaluddinM. Cancer cervix – a retrospective study. J Prev Soc Med1999; 18(1): 30–34.
35.
NgelangelCMuñozNBoschF. Causes of cervical cancer in the Philippines: a case-control study. J Natl Cancer Inst1998; 90(1): 43–49.
36.
de SanjoséSBoschFMuñozN. Social differences in sexual behaviour and cervical cancer. IARC Sci Publ1997138309–317.
37.
HerreroRBrintonLReevesW. Risk factors for invasive carcinoma of the uterine cervix in Latin America. Bull Pan Am Health Organ1990; 24(3): 263–283.
38.
TáboraNBakkersJQuintW. Human papillomavirus infection in Honduran women with normal cytology. Cancer Causes Control2009; 20(9): 1663–1670.
39.
BinghamABishopACoffeyP. Factors affecting utilization of cervical cancer prevention services in low-resource settings. Salud Publica Mex2003; 45(suppl 3): S408–S416.
40.
PATH. Program for Appropriate Technology in Health (PATH). In: Proceedings of the Western Kenya Cervical Cancer Prevention Project (WKCCPP) dissemination workshop. Cervical Cancer Prevention Team, PATH, 2002. Seattle, WA. Nairobi: PATH.
41.
RositchAFGatugutaAChoiRY. Knowledge and acceptability of pap smears, self-sampling and HPV vaccination among adult women in Kenya. PLoS One2012; 7(7): e40766–e40766.
42.
Services KMoPHaSaMoM (ed). National Cervical Cancer Prevention Program: Strategic Plan 2012-2015. Nairobi, Kenya: National Cervical Cancer Prevention Program, 2012.
43.
StolerMSchiffmanMGroup ASCoUS-L-gSILTSA. Interobserver reproducibility of cervical cytologic and histologic interpretations: realistic estimates from the ASCUS-LSIL Triage Study. JAMA2001; 285(11): 1500–1505.
