MEDLINE/PubMed Journal Browser Search

Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

Title: The relationship between HIV infection and cervical intraepithelial neoplasia among women attending two family planning clinics in Nairobi, Kenya.
Author: Maggwa BN, Hunter DJ, Mbugua S, Tukei P, Mati JK.
Journal: AIDS; 1993 May; 7(5):733-8. PubMed ID: 8318180.
Abstract:
OBJECTIVE: To determine the relationship between HIV-1 infection and cervical intraepithelial neoplasia (IN) among women at relatively low risk for both conditions. DESIGN: A case-control study comparing women with cytological evidence of IN (cases) with those without IN (controls) and HIV-1 serostatus as the principal exposure of interest. METHODS: A total of 4058 women attending two family planning clinics in Nairobi, Kenya between October 1989 and May 1991 were enrolled following HIV pretest counseling and informed consent. Structured interviews by trained nurses and medical students were used to obtain data on social, demographic, contraceptive practice and sexual behavior variables. A Papanicolaou smear specimen for cervical cytology and an endocervical swab for gonorrhea culture were obtained. HIV-1 serostatus was determined by enzyme-linked immunosorbent assay and confirmed by Western blot; syphilis serostatus was determined by the rapid plasma reagin test. RESULTS: Eighty-two of the 4058 (2.02%) women had cytological evidence of IN. We observed a significant positive association between HIV-1 infection and IN that remained after controlling for sexual behavior, contraceptive practices and other potential confounding variables (odds ratio, 2.78; 95% confidence interval 1.32-5.85). clinical symptoms and signs were uncommon among the HIV-1-seropositive women, suggesting that they were still in the early stages of the infection. CONCLUSION: The risk of IN among women even in the early stages of HIV-1 infection is increased. Women attending 2 family planning clinics in Nairobi, Kenya, were enrolled in a study of risk factors for HIV infection between October 1989 and May 1991. Data were obtained using a structured questionnaire on social, demographic, medical, and sexual behavior. During pelvic examination, were obtained specimens, for a Papanicolaou (PAP) smear and for sexually transmitted disease (STDs). 4058 women had an interpretable smear (with both squamous and endocervical cells present). 82 of the 4058 (women 2.0% had cytological evidence of cervical intraepithelial neoplasia (CIN): 58 had CIN-I, 23 had CIN 11, and 1 had CIN III. Single women were at a reduced ask for CIN (multivariate odds ratio = OR, 0.25; 95% confidence interval = CI, 0.07-0.86). There was no consistent association between number of pregnancies and CIN, although there was some evidence of a protective effect of later age at first pregnancy (P for linear trend = 0.07 and 0.35 in the crude and multivariate analyses, respectively). Age at first intercourse of at least 19 years compared with an age of 16 years of under was protective against CIN (OR, 0.45; 95% CI, 0.20-0.97). Having more than one lifetime sex partner increased the risk of CIN (OR, 1.60; 95% CI, 0.86-2.99). Positive syphilis serology was associated with a doubling of risk (OR, 2.28; 95% CI, 0.6%-7.63). Oral, intrauterine, or injectable contraception was not significantly associated with CIN. Ten (4.9%) of the 205 HIV-seropositive women had CIN, compared with 72 (1.9%) of the 3853 HIV-seronegative women (OR, 2.69; 95% CI, 1.29-5.49). This positive association remained after controlling for sexual behavior and other risk factors. On clinical examination, enlarged cervical, axillary, or inguinal lymph nodes were detected in 5.1% of the HIV-seropositive women compared with 1.7% of the HIV-seronegative women. CIN was more common among 204 HIV-seropositive women with symptoms or signs consistent with immunodeficiency (weight loss, fever, diarrhea); however, none of these associations reached statistical significance.

[Abstract] [Full Text] [Related] [New Search]