Epidemiology of Cervical Squamous Intraepithelial Lesions in HIV Infected Women in Kenya: a cross-Sectional Study

Peter Memiah, Violet Makokha, Wangeci Mbuthia, Grace Wanjiku Kiiru, Solomon Agbor, Francesca Odhiambo, Sylvia Ojoo, Justice Mbizo, Samuel Muhula, Gabriel Mahasi, Sibhatu Biadgilign


Cervical cancer is the second most common cancer among women worldwide. Infection with the human immunodeficiency virus (HIV) and its related immunosuppression are associated with an increased risk of prevalent, incident, and persistent squamous intraepithelial lesions (SILs) of the cervix. The objective of the study was to describe the prevalence and predictors of high-risk HPV and cervical cancer to support the need for strengthening cervical cancer screening programs for HIV infected women in Kenya. A cross sectional study was conducted in a hospital in Central Kenya, Kiambu district. The study population constituted of HIV positive women attending the ART treatment clinic. A total of 715 HIV positive women initiated on Antiretroviral Therapy (ART) were enrolled in this study.  About 359 (52.1%) were less than 40 years of age and 644 (90.3%) of the patients were widowed. About 642 (92.6%) of the HIV infected women were in follow-up period of ≥ 1 year. The outcome/prognosis of the patients undergoing ICC was 3 cured, 5 good and 4 poor respectively. In a multivariable ordinal logistic regression analysis showed that for a one-unit decrease of CD4, we expect 1.23 log odds of increasing the severity of cervical cancer (B=1.23, P<0.015), given that all of the other variables in the model are held constant. In conclusion screening of all HIV infected women, who are under HIV care and treatment, enrolling patients on HAART with higher CD4 counts is recommended to see the net effect of HAART response. (Afr J Reprod Health 2015; 19[1]: 133-139).

Full Text:



Agosti JM GS: Introducing HPV vaccine in developing countries – key challenges and issues: New England Journal of Medicine 2007, 356(19):1908-1910 2. Massad LS RK, Anastos KM, Fruchter RG, and Palefsky JM, and Burk RD, et al.: Prevalence and predictors of squamous cell abnormalities in Papanicolaou smears from women infected with HIV-1. Women’s Interagency HIV Study Group J Acquired Immune Deficiency Syndrome 1999, 21:33-41 3. Massad LS AL, Benning L, Minkoff H, Greenblatt RM, Watts H, et al.: Evolution of cervical abnormalities among women with HIV-1: evidence from surveillance cytology in the Women’s Interagency HIV Study J Acquir Immune Defic Syndr 2001, 27 432-442 4. Centers for Disease Control. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. JAMA1993;269:729–730. 5. Bosch FX LA, Munoz N, Meijer CJ, Shah KV.: The causal relation between human papillomavirus and cervical cancer J Clin Pathol 2002, 55:244-265. 6. Ferlay J BF, Pisani P, and Parkin DM: Globocan: Cancer incidence, Mortality and Prevalence Worldwide. IARC Press, Lyon, Version 1.0. IARC Cancer Base No.5. 2000. 7. Ellerbrock TV CM, Bush T, et al. : Incidence of cervical squamous intraepithelial lesions in HIV-infected women JAMA 2001, 283 1031-1037 8. Rabkin CS BR, Baptiste MS, Abe T, Kohler BA, Nasca PC Cancer incidence trends in women at high risk of human immunodeficiency virus (HIV) infection Int J Cancer 1993, 55:208-212 9. Sun XW KL, Ellerbrock TV, Chiasson MA, Bush TJ, Wright TC Jr :Human papillomavirus infection in women infected with the human immunodeficiency virus N Engl J Med 1997, 337:1343-1349. 10. Ledergerber B TA, Egger M:: Risk of HIV related Kaposi's sarcoma and non-Hodgkin's lymphoma with potent antiretroviral therapy: a prospective cohort study. Swiss HIV Cohort Study BMJ 1999, 319:2324. 11. LP J: Impact of potent antiretroviral therapy on the

Memiah et al. Cervical Squamous Intraepithelial Lesions in HIV Infected Women

African Journal of Reproductive Health March 2015; 19 (1): 139

incidence of Kaposi's sarcoma and non-Hodgkin's lymphoma among HIV-infected individuals J Acquir Immune Defic Syndr 1999 21: 34-41. 12. Minkoff H AL, Massad L, et al. : The effect of highly active antiretroviral therapy on cervical cytologic changes associated with oncogenic HPV among HIVinfected women. AIDS 2001, 15:2157-2164 13. Gates AE KL: AIDS malignancies in the era of highly active antiretroviral therapy Oncology 2002, 16:657- 665 14. Sahasrabuddhe LFBaVV: The impact of antiretroviral therapy on HPV and cervical intraepithelial neoplasia: current evidence and directions for future research. Infectious Agents and Cancer 2010, 5(8). 15. Strickler HD BR, Fazzari M, Anastos K, Minkoff H, et al. : Natural history and possible reactivation of human papillomavirus in human immunodeficiency viruspositive women J Natl Cancer Inst 2005, 97:577-586. 16. Franceschi S JH: Cervical cancer screening of women living with HIV infection: a must in the era of antiretroviral therapy Clin Infect Dis 2007, 45:510513. 17. Peter Memiah W, Grace Kiiru, Solomon Agbor, Francesca Odhiambo, Sylvia Ojoo, and Sibhatu Biadgilign Prevalence and Risk Factors Associated with Precancerous Cervical Cancer Lesions among HIV-Infected Women in Resource-Limited Settings. AIDS Research and Treatment 2012. 18. Pecorelli S, Benedet J, Creasman W, Shepherd J: FIGO Staging of gynecologic cancer. 1994-1997 FIGO Committee on Gynecologic Oncology: International Federation of Gynecology and Obstetrics. J Gynaecol Obstet 1999, 65:243-9. 19. Terrumun Z Swende SDN, Laadi T Swende: Prevalence and risk factors for cervical squamous intraepithelial lesions among women infected with HIV-1 in Makurdi, Nigeria International Journal of Women’s Health 2012:, 4:55-60. 20. Agaba PA TT, Ekwempu CC, Idoko JA. : Cervical dysplasia in Nigerian women infected with HIV Int J Gynecol Obstet 2009, 107:99-102. 21. Schuman P OS, Klein RS, Duerr A, Cu-Uvin S, Jamieson DJ, Anderson J, Shah KV Longitudinal study of cervical squamous intraepithelial lesions in human immunodeficiency virus (HIV) seropositive and atrisk HIV-seronegative women J Infect Dis 2003, 188:128-136 22. Lillo FB FD, Veglia F, Origoni M, Grasso MA, Lodini S, Mastrorilli E, Taccagni G, Lazzarin A, Uberti-Foppa C: Human papillomavirus infection and associated cervical disease in human immunodeficiency virusinfected women: effect of highly active antiretroviral therapy J Infect Dis 2001, 184:547-551. 23. Kapiga S, Msamanga G, Spiegelman D, Mwakyoma H,

Fawzi W, Hunter D: Risk factors for cervical squamous intraepithelial lesions among HIV-1 seropositive women in Dar es Salaam,Tanzania. Int J Gynaecol Obstet 1999, 67(2):87-94. 24. Teixeira N, Araújo A, Correa C, Lodi C, Lima M, Carvalho NO, Castillo D, Melo V: Prevalence and risk factors for cervical intraepithelial neoplasia among HIV-infected women. Braz J Infect Dis 2012 16(2):164-169 25. Heard I, Potard V, Foulot H, Chapron C, Costagliola D, Kazatchkine M: High rate of recurrence of cervical intraepithelial neoplasia after surgery in HIV-positive women. J Acquir Immune Defic Syndr 2005, 39(4):412-418. 26. Mangclaviraj S, Kerr S, Chaithongwongwatthana S, Ananworanich J, Hirschel B, Emery S, Cooper D, Chotnopparatpattara P, Ruxrungtham K, Phanuphak P: Nadir CD4 count and monthly income predict cervical squamous cell abnormalities in HIV-positive women in aresource-limited setting Int J STD AIDS 2008 19(8):529-532 27. Obure J, Olola O, Swai B, Mlay P, Masenga G, Walmer D: Prevalence and severity of cervical squamous intraepithelial lesion in a tertiary hospital in northern Tanzania. Tanzan J Health Res 2009, 11(4):163-169. 28. CDC: Centers for Disease Control and Prevention. Vaccines and preventable diseases: HPV vaccine – questions and answer. 2011. 29. Atashili J, Adimora A, Ndumbe P, Ikomey G, Rinas A, Myers E, Eron J, Smith J, Miller W: High prevalence of cervical squamous intraepithelial lesions in women on antiretroviral therapy in Cameroon: Is targeted screening feasible? Cancer Epidemiol 2012, 36(3):263-269. 30. Lambert CC: Factors influencing cervical cancer screening in women infected with HIV: a review of the literature J Assoc Nurses AIDS Care 2013, 24(3):189-197. 31. Palefsky J: Cervical human papillomavirus infection and cervical intraepithelial neoplasia in women positive for human immunodeficiency virus in the era of highly active antiretroviral therapy. Curr Opin Oncol 2003, 15(5):382-388. 32. McKenzie K, Rogers R, Njoroge J, John-Stewart G, Richardson B, Mugo N, Vuyst HD, Pamnani R, Rana F, Warui D et al: Cervical squamous intraepithelial lesions among HIV-positive women on antiretroviral therapy in Kenya. Curr HIV Res 2011 9(3):180-185 33. Ahdieh-Grant L, Li R, Levine A, Massad L, Strickler H, Minkoff H, Moxley M, Palefsky J, Sacks H, Burk R et al: Highly active antiretroviral therapy and cervical squamous intraepithelial lesions in human immunodeficiency virus-positive women. J Natl Cancer Inst 2004 96(14):1070-1076.


  • There are currently no refbacks.