title: Cervical cancer risk factors among HIV-infected Nigerian women.
abstract: BACKGROUND
  Cervical cancer is the third most common cancer among women worldwide, and in Nigeria it is the second most common female cancer. Cervical cancer is an AIDS-defining cancer; however, HIV only marginally increases the risk of cervical pre-cancer and cancer. In this study, we examine the risk factors for cervical pre-cancer and cancer among HIV-positive women screened for cervical cancer at two medical institutions in Abuja, Nigeria.
  
  
  METHODS
  A total of 2,501 HIV-positive women participating in the cervical cancer screen-and-treat program in Abuja, Nigeria consented to this study and provided socio-demographic and clinical information. Log-binomial models were used to calculate relative risk (RR) and 95% confidence intervals (95%CI) for the risk factors of cervical pre-cancer and cancer.
  
  
  RESULTS
  There was a 6% prevalence of cervical pre-cancer and cancer in the study population of HIV-positive women. The risk of screening positivity or invasive cancer diagnosis reduced with increasing age, with women aged 40 years and older having the lowest risk (RR=0.4; 95%CI=0.2-0.7). Women with a CD4 count of 650 per mm3 or more also had lower risk of screening positivity or invasive cancer diagnosis (RR=0.3, 95%CI=0.2-0.6). Other factors such as having had 5 or more abortions (RR=1.8, 95%CI=1.0-3.6) and the presence of other vaginal wall abnormalities (RR=1.9, 95%CI=1.3-2.8) were associated with screening positivity or invasive cancer diagnosis.
  
  
  CONCLUSIONS
  The prevalence of screening positive lesions or cervical cancer was lower than most previous reports from Africa. HIV-positive Nigerian women were at a marginally increased risk of cervical pre-cancer and cancer. These findings highlight the need for more epidemiological studies of cervical cancer and pre-cancerous lesions among HIV-positive women in Africa and an improved understanding of incidence and risk factors.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
authors.forename: Uzoma
authors.initials: U
authors.lastname: Ononogbu
authors.forename: Maryam
authors.initials: M
authors.lastname: Almujtaba
authors.forename: Fatima
authors.initials: F
authors.lastname: Modibbo
authors.forename: Ishak
authors.initials: I
authors.lastname: Lawal
authors.forename: Richard
authors.initials: R
authors.lastname: Offiong
authors.forename: Olayinka
authors.initials: O
authors.lastname: Olaniyan
authors.forename: Patrick
authors.initials: P
authors.lastname: Dakum
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.forename: William
authors.initials: W
authors.lastname: Blattner
authors.forename: Clement
authors.initials: C
authors.lastname: Adebamowo
mesh_terms: D000328:Adult; D016010:Binomial Distribution; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology