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Category: Volume 06 Issue 06 June 2018
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Title: Abnormal Cervical Epithelial Cytology in HIV-Seropositive Women and Correlation with CD4 Counts and Viral Load in Uyo, Akwa Ibom State, Nigeria

Authors: Onwuka Chidi Okorie (MBBS, FMC Path, FWACP), Dr Ojeh Samuel Ohidueme (FWACS), Adekunbiola A.F. Banjo (MBBS, FMC Path, MSc Clinical Cytology, FIAC)

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i6.28

Abstract

Background: In regions where HIV prevalence is high and HPV vaccine coverage is low, the interactions between HPV and HIV infections is expected to increase the incidence of cervical neoplastic lesions. This is the case in Uyo, Akwa Ibom State.

Objective: This case-control, cross-sectional study was carried out to determine the prevalence of cervical epithelial abnormalities in HIV-seropositive women in Uyo and correlating it with their CD4 count and HIV viral load.

Methodology: Two hundred and thirty one (231) consenting HIV positive women were recruited and screened for cervical cancer and its precursor lesions using conventional Pap smear between February 2013 and April 2014. Pap smears were classified according to the 2001 Bethesda classification. HIV testing was done by two rapid tests (Determine and Unigold), CD4 count was measured by flow cytometry, while the HIV viral load was determined by semi-automated conventional PCR within two weeks of Pap smear screening.

Result: The samples 226 HPW were suitable for statistical analysis. The study participants were aged between 18-60 years with a mean age of 35.63±8.44. Majority of the study participants were between the ages of 25 years and 36 years. The mean CD4 count and the mean HIV viral load were 311.08±299.1 cells/mm3(range 6-1779) and 354449.51±1257979.9/microliter (range <400-9,623,070) respectively. The prevalence of abnormal cervical cytology was 10.6%. There is no significant correlation between the type of cytologic abnormality with the CD4 count and viral load, but HPW with a higher viral load had the lowest mean CD4 count and the worst cytologic abnormality. Women on longer duration of HAART treatment also had a higher mean CD4 count and better cytologic result. 10.9% of the HPW with a negative cytology report had inflammatory smears.

Conclusion: There is a positive association between HIV/AIDS and cervical neoplasia.  When the Viral load was grouped into those below 400 vs 401-10,000 vs >10,000 and the CD4 count grouped into those below 200 vs 200-499 vs above 500, a significant correlation was observed between the immune status and cytological abnormality. However, without grouping the CD4 counts and HIV viral loads, there is nosignificant correlation. We recommend therefore that, cervical cancer screening should be included in the protocol for the routine care of women living with HIV/AIDS in this region regardless of their CD4 counts and HIV viral loads.

Keywords: Cervix, Cytology, HIV, CD4 count and Viral load.

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Corresponding Author

Onwuka Chidi Okorie (MBBS, FMCPath, FWACP)

Department of Histopathology, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State Nigeria

+234 (0) 8035473424, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.