The Association between HIV Infection, Antiretroviral Therapy and Cervical Squamous Intraepithelial Lesions in South Western Nigerian Women

Abstract

IntroductionFindings from studies that evaluated the effect of antiretroviral drug use on the development of cervical squamous intraepithelial lesion differed in their conclusions. This study investigated the association between HIV infection, antiretroviral drug use and cervical squamous intraepithelial lesion in a high HIV and cervical cancer burden setting- Nigeria.MethodsA cross sectional study among 1140 women of known HIV status enrolled in a randomised study to determine the test characteristics of visual inspection in detecting cytology diagnosed squamous intraepithelial lesion. Multivariate analysis was used to determine the association between HIV infection, antiretroviral drug use and the twin outcome variables of cervical squamous intraepithelial lesion (SIL) and High grade squamous intraepithelial lesion (HSIL) while controlling for confounders.ResultsPrevalence of cervical squamous intraepithelial lesion was 8.5%, with a higher prevalence of 14.3% in HIV positive compared to 3.3% in HIV negative women (aOR: 5.4; 95% CI: 2.9–8.8). Not using antiretroviral drugs was found to be associated with an increased risk of SIL (aOR: 2.1; 95% CI: 1.4–3.5) and HSIL (aOR: 2.6; 95% CI: 1.1–6.4). Participants who had a CD4 cell count <200 cells/mm3, were also found to be at increased risk for SIL (aOR: 1.9; 95% CI: 1.1–5.9) and HSIL (aOR: 5.7; 95% CI: 1.1–7.2).ConclusionHIV infection and severe immunosuppression were found to be associated with increased risk of cervical squamous intraepithelial lesion but not viral load. For the first time, in the West African sub-region with specific HIV type and strains, we established the protective effect of antiretroviral drug use against the development of SIL. Integration of cervical cancer screening programme into HIV services and early initiation of antiretroviral drug in HIV positive women especially those with severe immune-suppression could therefore prove to be useful in preventing and controlling cervical cancer development in HIV positive women.

Papanicoleau Smear Usage and Prevalence of Premalignant Cervical Lesion among Women Living with HIV Attending a Federal Teaching Hospital in South-West Nigeria: A Comparative Study

“…This prevalence is higher than 12.6% and 4.6% found by Dim et al [27] among HIV positive and HIV negative women respectively. Ezechi et al [28] also found a similar prevalence with Dim, 14.3% and 3.3% among HIV positive and negative women respectively. Anorlu et al [8] also got a similar prevalence of 10.9% and 4.3% among HIV positives and negatives respectively.…”

Highly active antiretroviral therapy and cervical cytologic abnormalities among women with HIV infection in a limited‐resource setting

“…The introduction of HAART has revolutionized the management of people infected with HIV and has led to improved survival, with a reduction in opportunistic infections and HIV‐related neoplastic and non‐neoplastic diseases . However, its impact on the prevalence and the progression or regression of premalignant lesions of the cervix remains unclear with conflicting reports from many researchers …”

“…Moreover, women with cervical cytologic abnormalities at baseline had a significantly increased likelihood of regression if they were using HAART. In Lagos, Nigeria, Ezechi et al . found two‐times increased odds for low‐grade squamous intraepithelial lesions and almost three‐times increased odds for high‐grade squamous intraepithelial lesions among 1140 women who did not receive HAART.…”

“…In Nigeria, only one study seems to have evaluated the relationship between the use of HAART and cervical cytologic abnormalities among HIV‐positive women. The main aim of the present study was to determine whether the use of HAART is associated with a significant reduction in the risk of cervical cytologic abnormalities among women with HIV infection attending the adult HIV clinic at Nnamdi Azikiwe University Teaching Hospital.…”

The Human papillomavirus among women living with Human Immunodeficiency Virus in Morocco A prospective cross-sectional study

“…In addition, the impact of HAART on HPV-associated lesions remains controversial [19,20]. Furthermore, previous data reported that HIV-positive women have a 2-to 12-fold higher risk of CIN lesions compared to HIV-negative women [21,22]. Therefore, the accurate assessment of the burden of HIV/HPV co-infection is of great importance.…”