title: Prevalence and predictors of squamous intraepithelial lesions of the cervix in HIV-infected women in Lusaka, Zambia.
abstract: OBJECTIVE
  HIV-infected women living in resource-constrained nations like Zambia are now accessing antiretroviral therapy and thus may live long enough for HPV-induced cervical cancer to manifest and progress. We evaluated the prevalence and predictors of cervical squamous intraepithelial lesions (SIL) among HIV-infected women in Zambia.
  
  
  METHODS
  We screened 150 consecutive, non-pregnant HIV-infected women accessing HIV/AIDS care services in Lusaka, Zambia. We collected cervical specimens for cytological analysis by liquid-based monolayer cytology (ThinPrep Pap Test) and HPV typing using the Roche Linear Array PCR assay.
  
  
  RESULTS
  The median age of study participants was 36 years (range 23-49 years) and their median CD4+ count was 165/microL (range 7-942). The prevalence of SIL on cytology was 76% (114/150), of which 23.3% (35/150) women had low-grade SIL, 32.6% (49/150) had high-grade SIL, and 20% (30/150) had lesions suspicious for squamous cell carcinoma (SCC). High-risk HPV types were present in 85.3% (128/150) women. On univariate analyses, age of the participant, CD4+ cell count, and presence of any high-risk HPV type were significantly associated with the presence of severely abnormal cytological lesions (i.e., high-grade SIL and lesions suspicious for SCC). Multivariable logistic regression modeling suggested the presence of any high-risk HPV type as an independent predictor of severely abnormal cytology (adjusted OR: 12.4, 95% CI 2.62-58.1, p=0.02).
  
  
  CONCLUSIONS
  The high prevalence of abnormal squamous cytology in our study is one of the highest reported in any population worldwide. Screening of HIV-infected women in resource-constrained settings like Zambia should be implemented to prevent development of HPV-induced SCC.
authors.affiliation: School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA, and University Teaching Hospital, Lusaka, Zambia. gparham@uabmc.edu
authors.forename: Groesbeck P
authors.initials: GP
authors.lastname: Parham
authors.forename: Vikrant V
authors.initials: VV
authors.lastname: Sahasrabuddhe
authors.forename: Mulindi H
authors.initials: MH
authors.lastname: Mwanahamuntu
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.forename: Michael L
authors.initials: ML
authors.lastname: Hicks
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Stringer
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000600:supply & distribution; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification; D015995:Prevalence; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000517:prevention & control* / Q000821:virology; D014626:Vaginal Smears; D016387:Women's Health; D015024:Zambia / Q000453:epidemiology; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000517:prevention & control* / Q000821:virology
chemical_list: D019380:Anti-HIV Agents