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Abstract

To determine the prevalence and predictors of cervical squamous intraepithelial lesions (SIL) among HIV-infected women in Tanzania, a cross-sectional study was conducted among HIV-infected women at HIV care and treatment clinics. A Papanicolaou (Pap) smear was used as a screening tool for detection of cervical SIL. From December 2006 to August 2009, 1365 HIV-infected women received cervical screening. The median age was 35 (interquartile range [IQR]: 30–42) years, and the median CD4 + cell count was 164 (IQR: 80–257) cells/mm³. The prevalence of cervical SIL was 8.7% (119/1365). In multivariate analysis, older age (≥50 versus 30–<40 years: prevalence ratio [PR], 2.36; 95% confidence interval [CI], 1.45–3.84, p for trend = 0.001), lower CD4 + cell counts (<100 versus ≥200 cells/mm³: PR, 1.55; 95% CI, 1.01–2.36, p for trend = 0.03) and cervical inflammation (PR, 1.73; 95% CI, 1.16–2.60, p = 0.008) were associated with an increased risk of cervical SIL. Women with advanced WHO HIV disease stage (IV versus I/II: PR, 3.45; 95% CI, 1.35–8.85, p for trend = 0.01) had an increased risk for high-grade SIL. In resource-limited settings where it is not feasible to provide cervical cancer prevention services to all HIV-infected women, greater efforts should focus on scaling-up services among those who are older than 50 years, with lower CD4 cell counts and advanced HIV disease stage.

Keywords

HIV AIDS human papillomavirus HPV prevalence risk factors cervical squamous intraepithelial lesions Papanicolaou (Pap) smear HIV-infected women Tanzania

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Prevalence and risk factors of cervical squamous intraepithelial lesions among HIV-infected women in Dar es Salaam,Tanzania

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