Prevalence and factors associated with precancerous cervical lesions among HIV- positive women attending Mulago Hospital, Uganda

Abstract

Background: Cervical cancer is the most common cancer in women in low-income countries, including Uganda. Although cervical cancer incidence and mortality is higher in HIV-positive women, resource limitations restrict the implementation of systematic screening programs in these women.

Objective: This study was conducted to determine the prevalence and factors associated with precancerous cervical lesions in HIV-positive women attending Mulago Hospital.

Methods: A cross-sectional study of HIV positive women attending Mulago ISS clinic was carried out. A total of 301 women meeting the inclusion criteria were screened for precancerous cervical lesions using VIA and those found to be VIA positive were further evaluated by colposcopy and biopsy of the suspicious lesion taken for histology. A standardized questionnaire was administered to obtain data on socio-demographic, medical and behavioral characteristics. Data entry was performed using Epi Data 3.1 and STATA software was used for Univariate, Bivariate and Multivariate analysis to assess factors associated with precancerous cervical lesions among this study population.

Results: Out of 301 HIV positive women screened with VIA, 13.6% (41/301) demonstrated precancerous cervical lesions. On further testing, 11 out of 41 women had suspicious lesions (9 LGSIL and 2 HGSIL) which were biopsied for histology, of these, 36.4% (4/11) were CIN3 and 63.6%(7/11) were CIN1. No invasive cervical cancer case was observed in this study. The following factors were significantly associated with precancerous cervical lesions: parity ≥ 4(OR 2.59, 95%CI1.18 5.68) and CD4+ cell count (>350cells/μl) (OR 0.17, 95%CI0.06 0.47). Use of HAART was significantly associated with lower prevalence of precancerous cervical lesions (OR 0.25, 95%CI 0.09 0.72).

Conclusion: The prevalence of precancerous cervical lesions in HIV positive women attending Mulago hospital is 13.6% (41/301) at VIA and 1.33% (4/301) at biopsy. Parity of 4 and above, not using HAART and CD4+ cell count below 350cells/mm3 were the major associated factors.

Recommendation: Scale up targeted screening for precancerous cervical lesions and treatment based on VIA results in HIV positive women, preferably integrated within the Mulago ISS clinic. Increase sensitization of PLWHIV to have regular screening for abnormal lesions and on identified major associated factors to precancerous cervical lesions.