title: Risk factors for cervical precancer detection among previously unscreened HIV-infected women in Western Kenya.
abstract: HIV and cervical cancer are intersecting epidemics in many low-resource settings, yet there are few accurate estimates of the scope of this public health challenge. To understand disease prevalence and risk factors for cervical intraepithelial neoplasia 2 or greater (CIN2+), we conducted a cross-sectional study of women undergoing cervical cancer screening as part of routine HIV care in Kisumu, Kenya. Women were offered screening with visual inspection with acetic acid, followed by confirmation with colposcopy and biopsy as needed. Univariable and multivariable analyses were carried out to determine clinical and demographic predictors of prevalent CIN2+. Among 3,241 women screened, 287 (9%) had an initial diagnosis of biopsy-confirmed CIN2+. On multivariable analysis, combined oral contraceptives remained significantly associated with detection of CIN2+ among women on HAART (AOR 1.84, CI 1.20-2.82), and not on HAART (AOR 1.72, 95% CI 1.08-2.73), while use of a progesterone implant was associated with increased detection of CIN2+ (AOR 9.43, 95% CI 2.85-31.20) only among women not on HAART. CD4+ nadir over 500 cells/mm(3) was associated with reduced detection of CIN2+ (AOR 0.61, CI 0.38, 0.97) in the overall group, but current CD4+ was only associated with reduced detection of CIN2+ among women not on HAART (AOR 0.42, CI 0.22, 0.80). In conclusion, a history of less severe immunosuppression appeared to reduce the risk of CIN2+ detection, but current CD4+ count was significant only in non-HAART users. The association of CIN2+ with hormonal contraception should be explored more in prospective studies designed to better control for confounding factors.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA.
authors.forename: Megan J
authors.initials: MJ
authors.lastname: Huchko
authors.forename: Hannah
authors.initials: H
authors.lastname: Leslie
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sneden
authors.forename: May
authors.initials: M
authors.lastname: Maloba
authors.forename: Naila
authors.initials: N
authors.lastname: Abdulrahim
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D011230:Precancerous Conditions / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology
keywords: HIV; Kenya; cervical cancer; cervical intraepithelial neoplasia
references.citation: Gynecol Oncol. 2012 Dec;127(3):440-50
references.pmid: 22940493
references.citation: J Obstet Gynaecol. 2008 Aug;28(6):638-41
references.pmid: 19003664
references.citation: Antivir Ther. 2006;11(8):1091-6
references.pmid: 17302379
references.citation: J Natl Cancer Inst. 2009 Aug 19;101(16):1120-30
references.pmid: 19648510
references.citation: AIDS Res Treat. 2012;2012:953743
references.pmid: 22548156
references.citation: Int J Cancer. 2010 Dec 15;127(12):2893-917
references.pmid: 21351269
references.citation: Acta Biomed. 2007;78(1):36-40
references.pmid: 17687815
references.citation: PLoS One. 2013;8(1):e53494
references.pmid: 23326441
references.citation: PLoS Med. 2011 May;8(5):e1001032
references.pmid: 21610859
references.citation: Contraception. 2012 Mar;85(3):288-93
references.pmid: 22067748
references.citation: Gynecol Oncol. 2006 Dec;103(3):1017-22
references.pmid: 16875716
references.citation: Infect Agent Cancer. 2010 May 12;5:8
references.pmid: 20462441
references.citation: J Int AIDS Soc. 2012 Jun 18;15(2):17406
references.pmid: 22713260
references.citation: Int J Gynaecol Obstet. 2011 Apr;113(1):68-71
references.pmid: 21272884
references.citation: AIDS. 2012 Aug 24;26(13):1645-52
references.pmid: 22555167
references.citation: Obstet Gynecol. 2003 Jan;101(1):175-7
references.pmid: 12517664
references.citation: Br J Cancer. 2012 Oct 23;107(9):1624-30
references.pmid: 23033006
references.citation: J Int AIDS Soc. 2012 Feb 22;15(1):8
references.pmid: 22353553
references.citation: Int J Cancer. 2008 Jan 1;122(1):244-6
references.pmid: 17764116
references.citation: J Natl Cancer Inst. 2007 Jun 20;99(12):962-72
references.pmid: 17565153
references.citation: Gynecol Obstet Invest. 2011;71(2):93-103
references.pmid: 21150159
references.citation: Br J Cancer. 2010 Jul 27;103(3):416-22
references.pmid: 20588274
references.citation: Obstet Gynecol. 2008 Jun;111(6):1380-7
references.pmid: 18515522