title: Nadir CD4 count and monthly income predict cervical squamous cell abnormalities in HIV-positive women in a resource-limited setting.
abstract: We conducted a cross-sectional study with 385 HIV-positive women in Bangkok to assess the prevalence and predictors of cervical abnormalities on Papanicolaou (Pap) smear. Low-grade squamous intraepithelial lesions (LSIL), high-grade SIL (HSIL) and invasive cervical cell cancer (ICC) were assessed by cytological examination after Pap smear and logistic regression models were used to assess associations with patient characteristics. Overall prevalence of LSIL, HSIL and ICC were 11.2% (95% confidence interval [CI] 8.2-14.7%), 4.7% (95%CI 2.8-7.3%) and 0.5% (95%CI 0.06-1.9%), respectively. In multivariate models, only the nadir CD4 count and income remained significantly associated with cytological abnormalities, whereas smoking, hormonal contraceptive or antiretroviral use, condom use, parity and number of lifetime sexual partners were not associated. The odds ratio for having cytological abnormalities was 2.6 (95% CI 1.24-5.34) in those with a nadir CD4 count <200 cells/mm3 compared with those with a higher nadir CD4 count, and 1.99 (1.11-3.57) in those with an income of <125 US dollars/month compared with those with higher incomes. In settings where access to affordable treatment is improving, this study reinforces the importance of regular Pap smear screening in HIV-positive women, particularly those with low nadir CD4 counts and lower incomes.
authors.affiliation: Thai Red Cross AIDS Research Centre, Bangkok,Thailand.
authors.forename: Somsamorn
authors.initials: S
authors.lastname: Mangclaviraj
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kerr
authors.forename: Surasith
authors.initials: S
authors.lastname: Chaithongwongwatthana
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
authors.forename: Bernard
authors.initials: B
authors.lastname: Hirschel
authors.forename: Sean
authors.initials: S
authors.lastname: Emery
authors.forename: David A
authors.initials: DA
authors.lastname: Cooper
authors.forename: Pichai
authors.initials: P
authors.lastname: Chotnopparatpattara
authors.forename: Kiat
authors.initials: K
authors.lastname: Ruxrungtham
authors.forename: Praphan
authors.initials: P
authors.lastname: Phanuphak
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology*; D006801:Humans; D065006:Papanicolaou Test; D011203:Poverty; D011237:Predictive Value of Tests; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D014626:Vaginal Smears; D016387:Women's Health; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology*