title: Prevalence and risk factors of cervical squamous intraepithelial lesions among HIV-infected women in Dar es Salaam, Tanzania.
abstract: To determine the prevalence and predictors of cervical squamous intraepithelial lesions (SIL) among HIV-infected women in Tanzania, a cross-sectional study was conducted among HIV-infected women at HIV care and treatment clinics. A Papanicolaou (Pap) smear was used as a screening tool for detection of cervical SIL. From December 2006 to August 2009, 1365 HIV-infected women received cervical screening. The median age was 35 (interquartile range [IQR]: 30-42) years, and the median CD4 + cell count was 164 (IQR: 80-257) cells/mm(3). The prevalence of cervical SIL was 8.7% (119/1365). In multivariate analysis, older age (≥50 versus 30-<40 years: prevalence ratio [PR], 2.36; 95% confidence interval [CI], 1.45-3.84, p for trend = 0.001), lower CD4 + cell counts (<100 versus ≥200 cells/mm(3): PR, 1.55; 95% CI, 1.01-2.36, p for trend = 0.03) and cervical inflammation (PR, 1.73; 95% CI, 1.16-2.60, p = 0.008) were associated with an increased risk of cervical SIL. Women with advanced WHO HIV disease stage (IV versus I/II: PR, 3.45; 95% CI, 1.35-8.85, p for trend = 0.01) had an increased risk for high-grade SIL. In resource-limited settings where it is not feasible to provide cervical cancer prevention services to all HIV-infected women, greater efforts should focus on scaling-up services among those who are older than 50 years, with lower CD4 cell counts and advanced HIV disease stage.
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Enju
authors.initials: E
authors.lastname: Liu
authors.affiliation: National Cancer Institute, Center for Global Health, Rockville, MD, USA.
authors.forename: Renicha
authors.initials: R
authors.lastname: McCree
authors.affiliation: Africa Academy for Public Health, Dar es Salaam, Tanzania.
authors.forename: Expeditho
authors.initials: E
authors.lastname: Mtisi
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA Department of Nutrition, Harvard School of Public Health, Boston, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
authors.affiliation: Management and Development for Health, Dar es Salaam, Tanzania.
authors.forename: Eric
authors.initials: E
authors.lastname: Aris
authors.affiliation: Management and Development for Health, Dar es Salaam, Tanzania.
authors.forename: Irene A
authors.initials: IA
authors.lastname: Lema
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Hertzmark
authors.affiliation: Management and Development for Health, Dar es Salaam, Tanzania.
authors.forename: Guerino
authors.initials: G
authors.lastname: Chalamilla
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Nan
authors.initials: N
authors.lastname: Li
authors.affiliation: Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA.
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA Department of Nutrition, Harvard School of Public Health, Boston, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA stdls@hsph.harvard.edu.
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D065006:Papanicolaou Test; D015995:Prevalence; D012307:Risk Factors; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000453:epidemiology*; D013636:Tanzania / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology*
keywords: AIDS; HIV; HIV-infected women; HPV; Papanicolaou (Pap) smear; Tanzania; cervical squamous intraepithelial lesions; human papillomavirus; prevalence; risk factors