title: The association between HIV infection, antiretroviral therapy and cervical squamous intraepithelial lesions in South Western Nigerian women.
abstract: BACKGROUND
  Findings from studies that evaluated the effect of antiretroviral drug use on the development of cervical squamous intraepithelial lesion differed in their conclusions. This study investigated the association between HIV infection, antiretroviral drug use and cervical squamous intraepithelial lesion in a high HIV and cervical cancer burden setting- Nigeria.
  
  
  METHODS
  A cross sectional study among 1140 women of known HIV status enrolled in a randomised study to determine the test characteristics of visual inspection in detecting cytology diagnosed squamous intraepithelial lesion. Multivariate analysis was used to determine the association between HIV infection, antiretroviral drug use and the twin outcome variables of cervical squamous intraepithelial lesion (SIL) and High grade squamous intraepithelial lesion (HSIL) while controlling for confounders.
  
  
  RESULTS
  Prevalence of cervical squamous intraepithelial lesion was 8.5%, with a higher prevalence of 14.3% in HIV positive compared to 3.3% in HIV negative women (aOR: 5.4; 95% CI: 2.9-8.8). Not using antiretroviral drugs was found to be associated with an increased risk of SIL (aOR: 2.1; 95% CI: 1.4-3.5) and HSIL (aOR: 2.6; 95% CI: 1.1-6.4). Participants who had a CD4 cell count <200 cells/mm3, were also found to be at increased risk for SIL (aOR: 1.9; 95% CI: 1.1-5.9) and HSIL (aOR: 5.7; 95% CI: 1.1-7.2).
  
  
  CONCLUSIONS
  HIV infection and severe immunosuppression were found to be associated with increased risk of cervical squamous intraepithelial lesion but not viral load. For the first time, in the West African sub-region with specific HIV type and strains, we established the protective effect of antiretroviral drug use against the development of SIL. Integration of cervical cancer screening programme into HIV services and early initiation of antiretroviral drug in HIV positive women especially those with severe immune-suppression could therefore prove to be useful in preventing and controlling cervical cancer development in HIV positive women.
authors.affiliation: Clinical Sciences Division, Nigerian Institute of Medical Research Yaba, Lagos, Nigeria; Social Medicine and Global Health, Faculty of Medicine, Lund University, Lund Sweden.
authors.forename: Oliver Chukwujekwu
authors.initials: OC
authors.lastname: Ezechi
authors.affiliation: Social Medicine and Global Health, Faculty of Medicine, Lund University, Lund Sweden.
authors.forename: Karen Odberg
authors.initials: KO
authors.lastname: Pettersson
authors.affiliation: Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Clement Abu
authors.initials: CA
authors.lastname: Okolo
authors.affiliation: Clinical Sciences Division, Nigerian Institute of Medical Research Yaba, Lagos, Nigeria.
authors.forename: Innocent Achaya O
authors.initials: IA
authors.lastname: Ujah
authors.affiliation: Social Medicine and Global Health, Faculty of Medicine, Lund University, Lund Sweden.
authors.forename: Per Olof
authors.initials: PO
authors.lastname: Ostergren
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D009549:Nigeria / Q000453:epidemiology; D012923:Social Class; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D014626:Vaginal Smears